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NURS 1110 Exam 1

history, nursing concepts, health concepts, safety, med admin 1

QuestionAnswer
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
Created by: pinklrt98