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NURS 1110 Exam 1
history, nursing concepts, health concepts, safety, med admin 1
| Question | Answer |
|---|---|
| Historic background of nursing | nurse = mother; nurse = slave; nurse = caregiver, largely religious; nurse = role in warfare, women criminals as nurses; Florence Nightingale = modern nursing; WWII = increased demand for nurses and education |
| Definitions of nursing | The patient is the focus and nursing includes the physical, emotional, social, and spiritual dimensions of that person. Prevention of illness and promotion/maintenance of health in addition to care during illness. Other definitions are more specific. |
| Status of nursing as a profession and a discipline | well-defined body of specific and unique knowledge; strong service orientation, recognized authority by a professional group, code of ethics, professional organization that sets standards, ongoing research, autonomy |
| sentinel event | an unexpected occurrence involving death or serious physical or psychological injury or risk thereof. These events signal the need for immediate investigation and response. |
| Types of nursing degrees | diploma; ADN; BSN; MSN; DNP/FNP or other doctoral level degree |
| Nursing organizations | International - International Council of Nurses (ICN); National - American Nursing Association (ANA), National League for Nursing (NLN); American Association of College Nursing (AACN), National Student Nurses' Association (NSNA) |
| Standards of nursing practice | defines activities that are specific and unique to nursing; allow nurses to carry out professional roles, serve as protection for nurses/patient/facility, and make nurses accountable for quality of practice |
| Nursing Practice Acts | laws established in each state to regulate the practice of nursing; define legal scope; require licensing of nurses; establish criteria for education and licensing; define terms and activities in nursing |
| The nursing process | major guidelines for nursing practice - integration of the art and science of nursing; used by the nurse to identify healthcare needs and carry out a plan of care; allows for use of critical thinking and holistic treatment |
| Current trends in nursing | nursing shortage, evidence-based practice, community-based nursing, decreased length of hospital stay, aging population, increase in chronic health conditions, culturally competent care, independent nursing practice |
| Five common modes of values transmission | 1. Modeling, 2. Moralizing, 3. Laissez-faire, 4. Rewarding and punishing, 5. Responsible choice |
| Seven steps in the valuing process | 1. Choosing freely, 2. Choosing from alternatives, 3. Choosing after consideration of consequences, 4. Prizing with pride and happiness, 5. Prizing with public affirmation, 6. Acting with incorporation of choice, 7. Acting with consistency and regu |
| Values clarification strategies in clinical practice | find out the patient's values, identify potential conflicts, ethics |
| Principle-based vs. care-based approaches to bioethics | principle-based - combines elements of utilitarian and deontologic theories and offers specific guidelines for practice; care-based approach - directs attention to the specific situation of the individual patient and outcome is based on individual patient |
| ANA code of ethics for nursing | set of ethical principles that reflect the primary goals, values and obligations of the nursing profession |
| Bill of Rights for Registered Nurses | aims to improve workplaces and ensuring nurses' ability to provide safe, quality patient care. Intended to empower nurses by making clear what is non-negotiable in the workplace. |
| Different types of ethical issues | ethical problems, ethical uncertainty, ethical dilemmas, ethical distress, ethical residue, ethical disengagement, ethical violations, ethical courage |
| Ethical framework and decision-making process for resolving ethical problems | Gather Data, Identify, Plan, Implement, Evaluate |
| Law | standard or rule of conduct established and enforced by the government that is intended to protect the rights of the public |
| Four sources of law | constitutions (ex, federal and state), statutory law (ex, Nurse Practice Acts), administrative law (ex, boards of nursing), common law (ex, decisions that are made in court that set precedents for future incidents) |
| Professional and legal regulation of nursing practice | Nurse Practice Acts define the legal scope of nursing practice and identify violations that can result in disciplinary action against a nurse; standards are developed by the profession and are used as guidelines for peer review |
| Credentialing | refers to ways in which professional competence is ensured and maintained |
| Accredidation | process by which an educational program is evaluated and recognized as having met certain standards |
| Licensure | process by which a state determines that a candidate meets certain minimum requirements to practice in the profession |
| Certification | process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area |
| Grounds for suspending or revoking a license or registration | requires due process; may be revoked due to drug or alcohol abuse, fraud, deceptive practices, criminal acts, disciplinary action, gross or ordinary negligence, physical or mental impairments |
| Intentional torts | assault, battery, defamation of character, invasion of privacy (including HIPAA violations), false imprisonment, fraud |
| Unintentional torts | negligence, malpractice |
| Personal areas of potential liability in nursing | assessment, diagnosis, outcome identification and planning, implementation, evaluation |
| Legal procedure | claim identified, defendants named, complaint filed in trial court if no resolution, defendant contests allegations, pretrial discovery, trial, verdict, appeals. |
| The nurse as a defendant, fact witness or expert witness | defendant - accused of malpractice; fact witness - has knowledge of incident; expert witness - has solid educational or experiential background related to the case but is not directly involved with the incident |
| Legal safeguards in nursing practice | informed consent or refusal, contracts, collective bargaining, competent practice, documentation, patient education, executing physician orders, whistle-blowing, adequate staffing, insurance, risk management, JHACO, pt bill of rights, Good Samaritan law |
| Incident reports | also called a variance or occurrence report; used by healthcare agencies to document the occurrence of anything out of the ordinary that results in harm, or potential harm, to a patient, employee or visitor. Used for quality improvement. |
| Laws affecting nursing practice | Occupational Safety and Health Act of 1970; Health Care Quality Improvement Act of 1986; laws concerning distribution and use of controlled substances; laws prohibiting discrimination and harrassment; HIPAA; restraints; ADA; living wills/DNR |
| health | state of complete physical, mental and social well-being |
| Holistic nursing | care that addresses the many dimensions that comprise the whole individual, including different definitions of health and illness; also includes care across the lifespan and community-based care |
| Health Illness continuum | health - illness and everything in between; people are rarely 100% healthy or 100% ill |
| Health promotion | behavior of an individual that is motivated by a personal desire to increase well-being and health potential |
| Wellness | active state of being healthy and living a lifestyle that promotes good physical, mental and emotional health |
| Illness Prevention | behavior motivated by a desire to avoid or detect disease, or to maintain functioning within the constraints of illness or disability |
| major health risk factors | age, genetic factors, physiologic factors, health habits, lifestyle, environment |
| Nurse's role in health promotion and each level of prevention | 3 levels of health promotion - Primary (education, immunizations), Secondary (growth/development screenings, recommending appropriate screenings), Tertiary (patient education to manage disease, |
| Complementary-integral therapies commonly used to promote wellness | .............. |
| Illness vs. disease | disease is a pathological change in the structure of function of the body or mind; illness is the body's response to the disease where a person;s level of function is changed compared to a previous level |
| Acute illness vs. chronic illness | acute - rapid onset, short in duration, often treatable; chronic - permanent change, irreversible alterations to normal anatomy or physiology, long period of care or support, may require rehab or special patient education |
| Role of the nurse in promoting health and preventing illness | Health Belief Model - encourage patients that screenings or other healthcare measures are important and necessary; Health Promotion Model - encourage patients to make healthy lifestyle choices |
| Characteristics of culture | guides what is acceptable behavior for people of a specific group; learned by each new generation through formal and informal experiences; social and physical environment impact practices; practices and believes evolve; influences how people view selves |
| Components of culturally competent assessment | ask patients how they want to be treated based on on values and beliefs; patient is primary informant; research cultural in advance if possible |
| Guidelines for relating to clients from different cultures | develop cultural self-awareness; develop cultural knowledge; accommodate cultural practices in healthcare; respect culturally based family roles; avoid mandating change; seek cultural assistance |
| Culturally congruent vs. culturally competent | culturally competent - awareness of cultural differences; culturally congruent - application of awareness into practice |
| Religious, biomedical and holistic health views and beliefs in different cultures | review box 2-4 on page 34-35 |
| Major issues that led to the development of community based nursing | changes in the healthcare system that made certain groups high-risk/vulnerable - ex, immigrants, poor, homeless, abused clients, clients who abuse substances, mentally ill, elderly |
| Competencies of successful community based nursing practice | caregiver, case manager, collaborator, educator, change agent, counselor, client advocate, epidemiologist |
| Factors that define community | specific population or group of people living in the same geographic area under similar regulations and having common values, interests, and needs. |
| Relationship between health and community | examples - availability of healthcare, housing codes, waste disposal, nutritional services for those in need, police and fire departments, pollution, recreational opportunities, violent crime or drug use |
| Acute care nursing vs. community-based nursing vs. community health nursing | acute care - general in hospitals, treats individual patients; community health - centered around individual and family healthcare needs that are unique to a certain population as a whole |
| Aspects of the community that affect individual health | social support system, community healthcare structure, economic resources, environmental factors |
| Basic principles of growth and development | orderly and sequential, follows predictable patterns, differentiated and integrated, occur at different states and rates, can be modified, pace of growth and development is specific for each person |
| Developmental tasks for young adulthood | selecting a mate, learning to live with a marriage partner, starting a family and rearing children, managing a home, getting started in an occupation, civic responsibility, finding a congenial social group |
| Developmental tasks for middle age | accepting and adjusting to physical changes, attaining and maintaining a satisfactory occupational performance, assisting adult children, relating to one's spouse as a person, adjusting to aging parents, achieving social and civic responsibilities |
| Developmental tasks for the older adult | adjusting to decreased physical strength and health, retirement and reduced income, death of a spouse, adapting social roles, establishing a specific affiliation with one's age group and satisfactory living arrangements |
| Physical changes of middle adulthood | middle adulthood - hormonal changes (menopause or andropause), fatty tissue redistribution, wrinkles, dry skin, gray hair/hair loss, decreased visual and auditory acuity, decreased cardiac output, muscle mass, strength and agility, loss of bone calcium |
| Implications for nursing practices that use a knowledge base of growth and development | Allows the nurse to provide better holistic care by understanding cognitive, psychosocial, moral and spiritual needs of the patient. |
| Biological theory of aging | Based on things like genetics, immune system function, cell death, free radicals and how they affect the physical body |
| Psyschosocial theory of aging | focuses on the changes to the psychosocial dimension and how a person must modify his or her self-image and self-concept to adapt to the normal physiologic changes of middle and older adulthood |
| Delirium | temporary state of confusion; generally resolves with treatment |
| Dementia | various organic disorders that progressively affect cognitive functioning; usually chronic; Alzheimer's disease is a form of dementia |
| Depression | extreme or prolonged sadness; often results in a distinct change in behavior; can be managed with meds and/or therapy |
| Loss of role identity in the elderly | happens when a person cannot find new roles to substitute for old ones, or when they cannot modify roles to fit a new context; may lead to a sense of feeling unneeded, loss of friends, control and self-identity |
| Dealth of a spouse/relative/friend and the effect on the elderly | may result in reversal of roles, stress, changes to living situation, loss of intimacy, changes to lifestyle |
| Income change in the elderly | more leisure time, some adults may not have adequate income after retirement and may have difficulty meeting financial needs |
| Culture in the elderly | changes in social roles, changes in family roles, new affiliations with other older adults, difficulty maintaining cultural values if removed from their community |
| Lack of mobility and the elderly | difficult maintaining independence, may need help with basic tasks, home health care, may require assisted living |
| Spirituality and the elderly | moral development is complete, many older adults become more spiritual in old age |
| Nursing interventions related to physiological, cognitive and psychosocial changes of aging | increased risk for infection, depression, injury, falls, anxiety, immobility, bleeding, compromised human dignity, loneliness, loss of independence; nurses should encourage independence but provide safe care |
| "Safe environment" in the healthcare setting | Patients may feel unsafe in any healthcare setting; consider effects on every level of Maslow's hierarchy; in a "safe" environment, the nurse recognizes risks to safety and corrects them |
| Factors that affect safety in an individual's environment | Developmental stage of the individual; Lifestyle choices such as occupation, social behavior, environment; Mobility; Sensory Perception; Knowledge; Ability to Communicate; Physical Health State; Psychosocial Health State |
| Trans-theoretical model of change | 5 phases: pre-contemplation, contemplation, preparation, action, maintenance |
| Hendrich II Fall Model | Quick assessment tool that allows nurses to identify a patient's fall risk by assigning points to 8 different categories. Confusion, depression, altered elimination, dizziness, gender, anticonvulsants, benzodiazeprines, "get up and go" test |
| Specific safety concerns for the adult and older adult | falls, fires, driving, accidental overdosing/polypharmacy, decreased sensory function, decreased mobility, impaired thinking due to age-related changes or mental illness |
| Nursing diagnoses for patients in unsafe situations | risk for falls, impaired mobility, increased risk for injury at home; intimate partner violence; abuse |
| Risks of using restraints | suffocation, impaired circulation, altered skin integrity, diminished muscle and bone mass, fractures, altered nutrition or hydration, aspiration or breathing difficulties, incontinence, chance in mental status |
| Health teaching interventions that promote safety | remind adults of effects of stress on lifestyle and health; counsel about unsafe health habits; counsel about domestic violence |
| Strategies to decrease risk for injury in the home | avoid fires, avoid falls, prevent accidents, avoid poisoning, regular health evaluations |
| Nursing interventions to prevent injury to patients in healthcare settings | minimize fall risk, minimize environmental hazards, use equipment properly, follow protocol for patient identification, high alert meds |
| Alternatives to using restraints | "sitter" or other person that can alert staff if patient is in danger; |
| Guidelines for applying and using restraints | assess the need carefully; explore alternatives; use least restrictive method; obtain MD order and evaluation every 24 hours; monitor patient frequently; reassure patient |
| Evaluating the effectiveness of safety interventions | Patient compliance, improved mobility, availability of support |
| Roles of major governing and accrediting agencies in relation to patient safety | Joint Commission accredits and holds hospitals accountable to certain standards of care |
| The infection cycle | Infectious agent -> Reservoir -> portal of exit -> means of transmission -> portal of entry -> susceptible host |
| Nursing interventions used to break the chain of infection | hand hygiene, sterilization, antibiotics, disposable supplies, transmission-based precautions, dry intact dressing, gloves, cover nose and mouth when coughing/sneezing, use of pesticides, proper disposal of sharps, masks/protective gear, immunizations |
| Stages of an infection | incubation period, prodromal stage, full stage of illness, convalescent period |
| Microorganisms that infect humans | bacteria, fungi, viruses, prions (proteins) |
| Characteristics of bacteria | classified by shape (cocci - spherical, bacilli - rod, spirochetes - spiral); cocci can be clumping (staph) or chains (strepto); gram positive or gram negative based on stain, anerobic or aerobic; most common source of infection in hospitals; abx can kill |
| Characteristics of fungi | plantlike organisms that are present in air, soil and water |
| Characteristics of viruses | smallest of all microorganisms, usually requires an immune response |
| Patients at risk for developing an infection | immuno-deficient, recent surgery patients, use of invasive medical devices |
| Factors that reduce the incidence of healthcare-associated infection | hand hygiene, sterilization, personal protective equipment, |
| Situations in which hand hygiene is indicated | before patient contact, after patient contact, after using the restroom, before preparing food or eating |
| Strategies for implementing CDC guidelines for standard and transmission-based precautions when caring for patients | Standard precautions - all patients, includes exposure to blood, body fluids, secretions, excretions, nonintact skin, mucous membranes; Transmission-based precautions - used in addition to standard precautions, includes airborne, droplet, contact |
| Medical Asepsis | clean technique; used for majority of procedures |
| Surgical Asepsis | sterile technique; used in PR, labor and delivery areas, certain diagnostic testing areas, certain bedside procedures (catheter insertion, sterile dressing changes, preparing or injecting medicine) |
| Pharmacokinetic concepts | What the body does to a drug as it moves through the body; Four processes: Absorption, Distribution, Metabolism, Excretion |
| Absorption | movement of a drug from the site of administration to the bloodstream; impacted by route, lipid solubility, blood flow, dosage form, conditions at site of administration |
| Distribution | transport of a drug from the bloodstream to the tissues; happens in the capillaries; dependent upon blood flow and drug's ability to leave the bloodstream; more blood = faster absorption; drugs bind to plasma proteins until released |
| Metabolism | biotransformation of a drug from active to inactive form; primarily happens in the liver; metabolism affects dosage for those with impaired liver function or increased liver metabolism |
| Excretion | elimination of inactive drug from the body; most drugs are excreted by the kidneys, some excreted in bile or via lungs (ex, anesthesia) |
| Therapeutic effect | intended effect of a drug |
| Adverse effects (side effects) | anything other than the therapeutic effect of a drug, usually predictable and tolerable |
| Allergic effect | immune response to a drug; can vary in severity; rash, hives, fever, anaphylaxis, Stevens-Johnson syndrome |
| Drug tolerance | body gets accustomed to a drug with continued use; larger dose needed to achieve the same effect |
| Toxic effect | when drugs are not properly metabolized or excreted; can cause permanent damage to organs or systems |
| Idiosyncratic effect | unpredictable or unusual effect - may be an opposite response, an under-response, or an over-response; thought to be related to genetic enzyme deficiency |
| Cumulative effect | occurs when the body cannot metabolize one dose of a drug before another dose is administered; can lead to toxicity |
| Interactions | when a drug is affected by other drugs, food, or substances; can be either beneficial (ex, acetaminophen + opioid is synergystic) or harmful (ex, alcohol + painkillers) |
| Teratogenic effect | potential for a drug to cause harm to a developing fetus because it can cross the placenta; greatest risk is during the first trimester |
| How gender influences the action or effect of a medication | differences in fat distribution, hormonal fluctuations, greater adverse effects and absorption in females, higher blood serum levels in females |
| How weight influences the action or effect of a medication | ratio between dose and weight affects distribution and concentration, dosage is often weight-dependent, larger adults require larger doses, children's doses are always calculated by weight, some drugs require body surface area calculations |
| How pathology influences the action or effect of a medication | diseases may influence the action of a drug (ADME); decreased blood flow affects ADME; decreased hepatic function affects metabolism; decreased renal function affects excretion; decreased GI function affects absorption |
| How the environment influences the action or effect of a medication | cultural and genetic influences, some drugs are more/less effective for certain populations; environment influences patient response; nutritional state impacts drug distribution, certain foods can influence absorption, attitudes can influence compliance |
| How age influences the action or effect of a medication | decreased gastric motility -> decreased absorption; decreased lean body mass -> decreased distribution; decreased renal function -> decreased excretion; decreased blood flow -> decreased ADME; decreased lipid content -> decreased absorption; toxicity risk |
| How pregnancy influences the action or effect of a medication | increased blood volume -> increased ADME; some drugs are harmful to the fetus |
| Therapeutic range | concentration in the blood serum producing desired effect without toxicity |
| Peak level | highest plasma concentration in blood serum after absorption |
| Trough level | lowest plasma concentration in blood serum (typically 30-60 minutes before the next dose) |
| Duration | how long a drug lasts |
| Half-life | time it takes for 50% of serum concentration to be eliminated from the body; 4-5 half lives before frug at steady state |
| Generic name of a drug | chemical name, identifies active ingredient; usually lowercase |
| Official name of a drug | name identified in official publications (ex, National Formulary) |
| Trade/Brand name of a drug | name selected by a drug manufacturer; trademarked; usually capitalized |
| Drug classifications | drugs are classified according to their effects on body systems, therapeutic uses, chemical characteristics |
| Analgesic | relieves pain |
| Anti-infective | drugs that kill an infectious agent or inhibit it from spreading |
| Anti-hypertensive | controls blood pressure |
| Anti-inflammatory | reduces inflammation |
| Anti-coagulant | prevents coagulation (clotting) of blood |
| Antidepressant | alleviates mood disorders |
| Diuretic | increases excretion of water |
| Anti-diabetics | lowers blood glucose levels |
| Coumadin | anti-coagulant; treatment of venous thrombosis, management of MI; BLEEDING; high alert med, requires frequent checks of INR levels |
| Digoxin | anti-arrhythmic; heart failure, atrial fibrillation, atrial flutter; fatigue, ARRHYTHMIA, bradycardia, anorexia, nausea, vomiting; monitor apical pulse for 1 full minute, hold if <60, high alert med |
| Lasix | diuretic; edema due to heart failure, liver failure, renal disease, hypertension; dehydration, hypo-everything, APLASTIC ANEMIA |
| Prednisone | corticosteroid, antiasthmatic; wide variety of chronic diseases, inflammatory or allergic reaction, auto-immune disorders; hypertension, PEPTIC ULCERATION, anorexia, nausea, acne, THROMBOEMBOLISM, cushingoid appearance, etc.; give in a.m. |
| Colace | laxative, stool softener; constipation; no common side effects; administer with full glass of water, assess abdomen, bowel sounds, stool; check on patient frequently and assist to bathroom if needed |
| Potassium Chloride | mineral and electrolyte replacement; potassium deficiency, digoxin toxicity; ARRHYTHMIAS, abdominal pain, diarrhea, flatulence, nausea, vomiting; monitor pulse, BP and ECG during IV therapy, never administer via IV push (must be diluted) |
| Percocet | opioid analgesic; moderate to severe pain; confusion, sedation, RESPIRATORY DEPRESSION, constipation; assess pain frequently, assess level of sedation, high alert med, controlled substance |
| Lipitor | lipid lowering agent; management of high cholesterol; abdominal cramps, constipation, diarrhea, flatus, heartburn, rash, RHABDOMYOLYSIS; use in conjunction with dietary restrictions, monitor liver function and cholesterol levels |
| Amoxicillin | anti-infective; treatment of various infections; SEIZURES, PSEUDOMEMBRANOUS COLITIS, diarrhea, rashes, ANAPHYLAXIS, SERUM SICKNESS; assess for infection frequently, observe for allergic reactions, monitor bowel functions, finish entire course |
| Regular insulin | anti-diabetic; management of type 1 and type 2 diabetes; HYPOGLYCEMIA, ANAPHYLAXIS; assess for hypo or hyperglycemia, high alert med, proper dosage is critical, use in conjunction with nutritional guidelines, administer 15-30 minutes before meal |
| NPH insulin | anti-diabetic; control of hyperglycemia in patients with type 1 or type 2 diabetes; HYPOGLYCEMIA, ANAPHYLAXIS, assess for hypo or hyperglycemia, high alert med, accurate dosing is critical, administer within 30-60 minutes before a meal |
| Atenolol | anti-anginal, anti-hypertensive, beta-blocker; management of hypertension, angina, prevention of MI; fatique, weakness, erectile dysfunction, BRADYCARDIA, CHF, PULMONARY EDEMA; take apical pulse for one minute before administering, hold if <50 |
| Ibuprofen | anti-pyretic, anti-rheumatic, nonopioid analalgesic, NSAID; mild to moderate pain, inflammatory disorders; headache, GI BLEEDING, HEPATITIS constipation, dyspepsia, nausea, vomiting, etc.; assess pain frequently, asses for GI bleeding |
| Aspirin | anti-pyretic, non-opioid analgesic, salicylate; inflammation, pain, fever, prevention of MI and transient ischemic attacks; GI BLEEDING, dyspepsia, nausea, epigastric distress; assess for pain, fever frequently, may prolong bleeding |
| Tylenol | anti-pyretic, non-opioid analgesic; mild pain, fever; HEPATIC FAILURE, HEPATOXICITY; assess pain or fever frequently |
| Glucophage | anti-diabetic; management of type 2 diabetes; abdominal bloating, diarrhea, nausea, vomiting, LACTIC ACIDOSIS; assess for symptoms of hypo or hyperglycemia; assess for symptoms of ketoacidosis or lactic acidosis, monitor blood glucose levels |
| Lotensin | anti-hypertensive, ACE inhibitor; management of hypertension; cough, hypotension, taste disturbances, AGRANULOCYTOSIS, ANGIOEDEMA; assess BP and pulse frequently, assess for angioedema, watch for precipitous drop in BP within 1-3 hours of first dose |
| Prozac | antidepressant, SSRI; major depressive disorder, OCD, panic disorder; anxiety, drowsiness, headache, insomnia, nervousness, diarrhea, sexual dysfunction, increased sweating, SUICIDAL THOUGHTS, SEIZURES, SEROTONIN SYNDROME; assess mood, careful dosage adj. |
| Aims of Nursing | 1. to promote health, 2. to prevent illness, 3. to restore health, 4. to facilitate coping with disability or death |
| International Council of Nurses definition of nursing | autonomous and collaborative care all ages, families, groups, and communities; includes the promotion of health, prevention of illness, and care of ill, disabled and dying; Advocacy, research, shaping health policy, system management are key roles. |
| American Nurses Association definition of nursing | nurses focus on human experiences/responses to birth, health, illness and death within the context of individuals, families and communities. Knowledge includes diagnosis, intervention and evaluation of outcome. Combines objective data with the subjective. |
| Four essential competencies of nurses | 1. cognitive, 2. technical, 3. interpersonal, 4. legal/ethical |
| Cognitive competencies of nurses | offering scientific rationale for patient's care; selection of nursing interventions that are most likely to yield desired outcomes; use of critical thinking skills |
| Technical competencies of nurses | Use of equipment; able to adapt equipment; hands-on skills |
| Interpersonal competencies of nurses | use of interactions with patients, families; work with patient to set and achieve health goals; communication; collaboration with healthcare team |
| Ethical and legal competencies of nurses | actions are consistent with personal moral code; effective patient advocates; accountable; follow professional code of ethics; follow legal guidelines |
| Florence Nightingale | defined nursing as both an art and a science; differentiated nursing from medicine; influential in establishment of nursing education; founder of modern nursing |
| Clara Barton | established the American Red Cross after nursing during the civil war |
| Dorothea Dix | Civil war nurse, pioneering crusader for reform of the treatment of the mentally ill |
| Mary Ann Bickerdyke | Civil war nurse, organized diet kitchens, laundries and an ambulance service |
| Louise Schuyler | Civil war nurse, recommended standards for nursing education |
| Linda Richards | first trained nurse in the United States |
| Jane Addams | women's rights, social services in neighborhoods, Nobel Peace Prize in 1931 |
| Lillian Wald | founder of public health nursing |
| Mary Elizabeth Mahoney | America's first African American nurse |
| Harriet Tubman | Nurse and abolitionist; active in underground railroad movement |
| Nora Gertrude Livingston | organized first 3-year training program for nurses at Montreal General Hospital |
| Mary Agnes Snively | founder of Canadian Nurses Association |
| Sojourner Truth | provides nursing care to soldiers during the civil war and worked for the women's movement. |
| Isabel Hampton Robb | leader in nursing and nursing education; organized nursing school at Johns Hopkins; implemented many policies re: hours worked |
| Mary Adelaide Nutting | first professor of nursing in the world; published History of Nursing |
| Elizabeth Smellie | Canadian Public Health nurse; organized Canadian Women's Army Corps during WWII |
| Lavinia Dock | Nursing leader and women's rights activist; instrumental in Constitutional amendment giving women the right to vote |
| Mary Breckenridge | Frontier Nursing Service and founder of one of the first midwifery schools in the US |
| Margaret Sanger | founder of Planned Parenthood |
| cultural assimilation | when people immigrate and encounter a new culture, they move closed to the dominant culture and adopt many of those characteristics |
| culture shock | feelings a person experiences when placed in a different culture perceived as strange |
| ethnicity | sense of identification with a collective cultural group, largely based on the group's common heritage |
| race | categories based on specific physical characteristics such as skin pigmentation, body stature, facial features, and hair texture. Five main classifications include: American Indian, Asian, Black, Pacific Islander, White. |
| cultural imposition | belief that everyone should conform to your own belief system |
| cultural blindness | occurs when one ignores the difference between different cultures and pretends that they do not exist |
| culture conflict | when people become aware of cultural differences, feel threatened an respond by ridiculing the beliefs or traditions of others |
| ethnocentrism | the belief that one's own ideas, beliefs and practices are the best, are superior, or are most preferred to those of others |
| disease | medical term that describes a pathologic change in the structure or function of the body or mind |
| stages of acute illness | 1. Experiencing Symptoms, 2. Assuming the Sick Role, 3. Assuming a Dependent Role, 4. Achieving Recovery and Rehabilitation |
| Factors affecting health status, beliefs, and practices | basic human needs; human dimensions (physical, emotional, intellectual, environmental, sociocultural, spiritual); self-concept; risk factors for illness or injury |
| Primary Health Promotion | focus is on prevention - examples include immunizations, lifestyle, alcohol/drug use, risky behavior |
| Secondary Health Promotion | focus is on early detection - examples include BP screening, Pap smears, mammograms, counseling |
| Tertiary Health Promotion | focus is on treating - medication, surgery, rehabilitation, PT/OT |
| Health Belief Model | People need to buy into the idea of screenings, preventative measures, and treatment. Largely depends on their attitude and how their health affects their lifestyle. Must understand the importance and necessity of healthcare |
| Health Promotion Model | how people interact with their environment as they pursue health; largely depends on individual characteristics, socioeconomic factors and how easy it is for people to make healthy lifestyle choices |
| Agent-Host-Environment Model | agent - environmental factor or stressor that must be present or absent for an illness to occur; host - living organism that capable of being infected by an agent; environment - all the factors external to the host that make illness more or less likely |
| Never event | Extremely rare medical errors that should never happen to a patient (eg, surgery on wrong body part or patient, leaving foreign object inside a person, discharging an infant to the wrong person) |
| Whistle-blowing | an effort by a member or past member of an organization to deliver a warning to the public concerning a serious wrongdoing or danger created or masked by the organization |
| Professional Values | Altruism, Autonomy, Human Dignity, Integrity, Social Justice |
| Values clarification | process by which people come to understand their own values and values system |
| Three main activities in valuing process | 1. Choosing, 2. Prizing (treasuring), 3. Acting |
| ethics | systematic inquiry into principles of right and wrong conduct, of virtue and vice, and of good and evil as they relate to conduct and human flourishing |
| morals | personal or communal standards of right and wrong |
| bioethics | refers to ethics related to the life sciences |
| clinical ethics | branch of bioethics concerned with ethical problems "at the bedside" when caring for actual patients |
| nursing ethics | branch of bioethics that is the formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments. |
| utilitarian theory of ethics | the rightness or wrongness of an action depends on the consequences of the action |
| deontologic theory of ethics | an action is right or wrong independent of its consequences |
| ethical distress | occurs when the nurse knows the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action |
| ethical dilemma | two or more clear moral principles apply, but support mutually inconsistent courses of action |
| Nurse-Patient ethical problems | paternalism, deception, confidentiality, allocation of scarce nursing resources, advocacy in market-driven environment, valid consent or refusal, conflicts between nurse's and patient's interest, conflicts concerning new technologies |
| Nurse-Physician ethical problems | Disagreements about proposed medical regimen; conflicts regarding the scope of the nurse's role; unprofessional, incompetent, unethical or illegal physician practice |
| Nurse-Nurse ethical problems | claims of loyalty; unprofessional, incompetent, unethical or illegal nurse practice |
| Nurse-Institution ethical problems | short staffing and whistle-blowing; healthcare rationing |
| Personal moral convictions vs. Institutional or Professional ethics | beginning-of-life issues, end-of-life issues |
| Physical changes of older adulthood | more difficulty maintaining homeostasis, decreased skin elasticity, thickened yellow nails, dry skin, hair loss, decreased muscle mass, tissue, weight, bone density, arthritis, decreased blood flow affects nearly every organ/system, hearing/vision loss |
| Erik Erikson | Psychosocial development; developmental crises; Identity vs. Role Confusion (Adolescence), Intimacy vs. Isolation (Young Adulthood), Generativity vs. Stagnation (Middle Adulthood), Integrity vs. Despair (Later Adulthood) |
| Robert J. Havinghurst | Developmental Tasks |
| Levinson and Associates | different phases of adult life depend on the self, the social and cultural aspects, and the set of roles in one's life. Stages include (1) Early adult transition, (2) Entering the adult world, (3) Settling down, (4) Midlife transition, (5) Pay-off years |
| Kohlberg's theory of moral development | Preconventional, Conventional, Postconventional. Most adults are at Stage 4 and above. |
| Carol Gilligan | Conception of morality from the female viewpoint. Three levels - Selfishness, Goodness, Nonviolence |
| James Fowler | Developmental theory centered around faith. Stages include Undifferentiated Faith, Intuitive Projective Faith, Mythica-Literal Faith, Synthetic-Conventional Faith, Individuative-Reflective Faith, Conjunctive Faith, Universalizing Faith. |
| Sigmund Freud | Theory of Psychoanalytic Development; the unconscious mind, the id, the ego and the superego; Oral stage, Anal stage, Phallic stage, Latency stage, Genital stage |
| Jean Piaget | Theory of Cognitive Development; Sensorimotor stage, Preoperational Stage, Concrete Operational Stage, Formal Operational Stage. Unless DD, most adults should fall under the Formal Operational Stage |
| Maslow's hierarchy of needs | Physiological, Safety, Social, Esteem, Self-Actualization |
| Safety risks in hospitals | Falls, fire, electrical hazards, chemical hazards, thermal hazards, radiation exposure, medical errors |
| How safety is regulated and monitored | Federal level (OSHA, FDA, CDC); State level (Dept. of Health); Local level (county licensing); Yourself |
| Types of medical errors | Medication errors, patient identification errors, incorrect treatments, potential problems with allergies |
| Fall prevention | Assess for history of falls or accidents; note assistive devices; be alert to history of drug or alcohol abuse; obtain knowledge of family support systems |
| Biggest fall risk factor | Previous falls |
| what nursing actions decrease risk of falls? | awareness of patient's environment; call light within reach; brakes on bed; assess level of awareness or orientation, mobility, ability to communicate, sensory perception, medications |
| Other factors that increase fall risk | Age > 65; history of falls; impaired vision or balance; altered gait or posture; medication regimen; postural hypotension; weakness, frailty; confusion, disorientation; unfamiliar environment |
| Joint Commission Safety Goals | improve patient identification (2 identifiers); improve communication among caregivers (report); improve safety of high alert meds; pause for the cause; infusion pump safety; clinical alarm system effectiveness; reduce risk of hospital-acquired infections |
| Joint Commission | national body that accredits hospitals |
| RACE | Rescue anyone in immediate danger; Activate the fire code and notify appropriate person; Confine the fire by closing doors and windows; Evacuate patients and other people to a safe area. |
| Guidelines for documenting errors | take care of the patient; report it; document thoroughly; inform the patient and family as needed; assess why it occurred. |
| nosocomial infection | hospital-acquired infection |
| Transient bacterial flora | attached loosely to the skin, can be removed with relative ease (ie, hand washing) |
| Resident bacterial floral | found in creases of skin, requires friction with brush to remove |
| Measures to reduce nosocomial infections | constant surveillance, written infection-prevention practice, hand hygiene, infection control precautions, keeping patients in best possible physical condition |
| Reservoirs for microorganisms | other humans, animals, soil, food, water, milk, inanimate objects |
| Common portals of exit | respiratory, gastrointestinal, genitourinary tracts, breaks in skin, blood and tissue |
| Lab data that indicates infection | elevated WBC count, increase in specific types of white blood cells, elevated erythrocyte sedimentation rate, presence of pathogen in urine, blood, sputum, or draining cultures |
| How drugs work | interact on the cellular level and turn processes "on/off"; promote or inhibit processes |
| sources of medication | plants, animals, minerals, synthetic compounds |
| Bioavailability | portion of a drug that reaches the bloodstream; 100% for IV meds, <100% for oral meds |
| cytochrome P450 | protein binding sites for drugs in the liver |
| Nursing Implications for medication administration | history, allergies, medication data, medication reconciliation, patient teaching |
| Prototype drug | first drug in a group to be developed |
| pharmacology | study that deals with chemicals that affect the body's functioning |
| anaphylactic reaction | life threatening allergic response tat results in respiratory distress, sudden severe bronchospasm and cardiovascular collapse |
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