Archer 2

What is justice?

Fairness; distributing care evenly

What is beneficence?

Doing good; doing the right thing for the patient

What is nonmaleficence?

Doing no harm; no intentional or unintentional care

What is accountability?

Accepting responsibility for your actions

What is fidelity?

Keeping your promises; staying true to professional responsibilities; fairness

Give an example of fidelity

Nurse not disclosing patient info without permission; telling patient what you will do and then doing it

What is autonomy?

Patient has the right to make their own decisions

What is veracity?

Telling the truth

What are advanced directives?

Set of instructions prepared in advance of ill health that determines healthcare wishes

What is a living will?

Type of advanced directive that becomes effective when a person is terminally ill

What is the goal of advanced directives?

Lets us know what the patient wants when they cannot communicate later on

What is medical power of attorney?

Designates who makes medical decisions for the patient if they are unable to make their own decisions

What is a tort?

Wrongful act or infringement of a right

What is negligence?

Failure to take proper care in doing something

What is malpractice?

Improper, illegal, or negligent professional activity or treatment

What is assault?

An act that threatens physical harm to a person (whether or not actual harm is done)

What is battery?

Unconsented physical contact with another person

What is false imprisonment?

Being imprisoned without legal authority

Give an example of false imprisonment in healthcare

Restraining someone who does not need to be restrained

Can you hold patients against their wishes without legal authority?

No

When is the local organ procurement organization notified?

If brain death is likely to be declared

Who discusses organ donation with the family?

Organ procurement organization (NOT the nurse or HCP)

What is the nurse's focus when caring for an organ donor?

Maintaining organ function (appropriate lab values and perfusion)

Nursing chain of command (lowest to highest) - 7 ppl

1	UAP (Unlicensed Assistive Personnel)
2	LPN (Licensed Practical Nurse)
3	RN (Registered Nurse)
4	Charge Nurse
5	Nurse Manager
6	Nursing Supervisor
7	Director of Nursing

Adverse event

Patient safety event that resulted in harm to a patient (ex: medication side effects, procedure complications)

No-harm event

Patient safety event that reaches the patient but does NOT cause harm

Close call / near-miss / good catch

Patient safety event that did NOT reach the patient

Hazardous (unsafe) condition

Circumstance (not related to patient's disease) that increases probability of an adverse event

What is a sentinel event?

Event that reaches patient AND causes harm (death, permanent harm, or severe temporary harm)

Is a sentinel event related to the patient's illness?

NO - unrelated to patient's illness or underlying condition

What two things must happen after a sentinel event?

Immediate investigation and response; reviewed by hospital and Joint Commission

Name 3 examples of sentinel events

Surgery on wrong site, wrong procedure, wrong-patient surgery

Name 4 components of case management

Knowledge of resources, equipment needs in home, plan of care, discharge info and coordination

Total Client Care Model

RN responsible for all aspects of care during a shift; can delegate; works directly with patient, family, and team

Primary Nursing Model

RN has caseload of patients and provides care for the SAME patients during their hospital stay

Team Nursing

Team members provide care under supervision of RN team leader

Autocratic management style

Manager makes all decisions

Democratic management style

Most decisions made by group with manager support

Participative management style

Staff provides input; manager makes final decision

Laissez-Faire management style

Manager not really involved; little structure

Transactional management style

Reward for doing well; consequence for doing poorly

What does performance appraisal help the nurse manager with?

Updating personnel records; staffing decisions (hiring, scheduling, promotions, termination)

Performance improvement

Formal evaluation system for job performance; recommends improvements and promotes professional growth

Benchmarking

Compares best practices from top hospitals; adapts methods to improve performance

Quality management

Overseeing all activities needed to maintain desired excellence (quality policy, planning, assurance, control/improvement)

Name 6 presumptive signs of pregnancy

Amenorrhea (no period >3 months), fatigue, enlarged breasts, sore breasts, increased urination frequency, quickening (fetal movement felt ~16-20 weeks), nausea/emesis

What is quickening?

First fetal movements felt by mother at ~16-20 weeks

Name 6 probable signs of pregnancy

Positive pregnancy test, ballottement, fetal outline palpable, Braxton Hicks contractions, Goodell's sign, Chadwick's sign, Hegar's sign, enlarged uterus

What is ballottement?

Tapping cervix where fetus floats away then rebounds back

What are Braxton Hicks contractions?

False labor contractions

What is Goodell's sign?

Softening of the cervix

What is Chadwick's sign?

Bluish color of cervix (due to increased vascularization)

What is Hegar's sign?

Lower uterine segment softens

Name 4 positive signs of pregnancy

Fetal movement felt by HCP, electronic device detects fetal heart sounds, delivery of fetus, ultrasound detects fetus, HCP sees fetal movement

What is Naegele's rule?

1st day of last menstrual period + 7 days - 3 months + 1 year = EDD

What does the fetus receive from the placenta?

Nutrients and oxygen

What does the fetus send back to the mother?

Waste products (ex: CO2)

When is fetal heart rate audible?

2nd trimester - month 4-7

How many additional calories per day during pregnancy?

~300 calories

What should be avoided with gestational diabetes?

Simple carbs

What does folic acid prevent in pregnancy?

Birth defects of spine and brain

What does DHA (omega-3) help with in pregnancy?

Eye and brain development in fetus

What does iodine help with in pregnancy?

Fetal brain and nerve growth

Fetal kick counts assessment

Count movements for 1 hour; should be at least 10

What does indirect Coombs test detect?

Anti-Rh antibodies in mother's blood

If mother has Rh antibodies present, the pregnancy is?

High risk

When is Rhogam typically given?

At 28 weeks if mother is Rh negative

How long does Rhogam last?

12 weeks

When must Rhogam be given after delivery if baby is Rh+?

Within 72 hours

When is GTT (glucose tolerance test) done?

~28 weeks

Steps for Glucose Tolerance test (up to 3 hr)

Step 1	Mother drinks 50g glucose; check BG at 1 hour
Cutoff for 3-hour test	If BG >140, proceed to 3-hour test
3-hour test prep	Fast for at least 8 hours
3-hour test process	Fasting sugar → drink 100g glucose → check BG at 1, 2, and 3 hours

What does NST assess?

Fetal well-being and oxygenation of placenta

Increase in FHR with movement = what on NST

Acceleration = GOOD

Decrease in FHR with movement = what on NST

Deceleration = BAD

What does a bad NST indicate?

Fetus will NOT tolerate labor

REACTIVE (GOOD) NST criteria

At least 2 accelerations of 15 bpm for 15 seconds in 20 minutes

NON-REACTIVE (BAD) NST criteria

Lower than 2 accelerations of 15 bpm for 15 seconds in 20 minutes

What test is done after non-reactive NST?

Contraction Stress Test

How are contractions induced for CST?

Oxytocin administration

Negative CST (NORMAL)

Baby had NO decelerations in response to contractions

Positive CST (BAD)

Baby had decelerations indicating distress

Normal fetal heart rate

110-160 bpm

Absent variability

<5 bpm or fewer

Non-reassuring

Marked variability

>25 bpm, jagged peaks/valleys

Too much; can be good or bad

Moderate variability

6-25 bpm

Normal/Reassuring

Early Decelerations (describe + cause)

Mirrors uterine contractions

Compression/stimulation of vagal nerve

NORMAL

Variable Decelerations (describe + cause)

Do NOT match contractions

Cord compression

EMERGENCY → C-section

Late Decelerations (describe + cause)

After contraction begins

Placental insufficiency (epidural, anemia, dehydration, hemorrhage)

BAD

What can the nurse do for pt with non-reassuring FHR?

Lay mother on LEFT side	Allows more blood return to heart and fetus
Increase IV fluids	Improve perfusion
Oxygen	Increase oxygenation
Notify PCP	Get help
Discontinue PITocin	PITocin causes more stressors

GTPAL - what it stands for and meaning

G	Gravidity	Number of pregnancies (twins count as 1)
T	Term	# of pregnancies carried to term (≥37 weeks)
P	Preterm	# of preterm births (20-37 weeks)
A	Abortions	# of pregnancies ending prior to 20 weeks
L	Living	# of children alive (NOT including fetus)

Melasma

Dark pigmentation on forehead/cheeks from hormones; lightens postpartum; wear sunscreen

What is hyperemesis gravidarum?

Intense morning sickness that does NOT subside

What can it hyperemesis gravidarum cause?

Dehydration, weight loss, electrolyte imbalances

Key feature of hyperemesis gravidarum

Cannot keep ANY food down

Name 3 antiemetics for hyperemesis gravidarum

Promethazine, Reglan, Compazine

What is the tX for hyperemesis gravidarum?

Antiemetics + IVF

When does preeclampsia occur?

After 20 weeks

BP criteria for diagnosis of preeclampsia

>140/90 (2 times, 4 hours apart) + protein in urine

What can preeclampsia lead to?

Eclampsia (seizures)

What can help prevent/control preeclampsia?

Low dose aspirin