NURS 403 Week 1 - Clinical Reasoning, Safety, and Person-Centered Care

What are the types of care settings?

Acute care, assisted living, long-term care, and ambulatory care.

What are the common units in the hospital and what are their nurses to patients ratio?

Emergency Department - 1:?

Med/Surg/Tele - 1:5 (1:4 for Tele)

SDU/DOU - 1:3

ICU - 1:1/2

What are the differences in Standard of Care between units?

Med/Surg/Tele: 1 Physical Assessment per shift; Vital signs every 4 hours

SDU/DOU: PA every 4 hours; VS every 2 hours

ICU: PA every 2 hours; VS every 1 hour

Who makes up the Acute Healthcare Team, and who is involved in each team?

Providers (can write prescriptions): MD, DO, NP, PA, PharmD

Nursing Team: House Supervisor, Charge RN, RRT/RRN, Staff/Bedside Nurse, LVN, CNA/PCT, Case Manager

Interprofessional Team: Radiology, Social Worker, Phlebotomy, Laboratory

What is the responsibility of Staff/Bedside RNs?

Managing patient care - they create and implement plans of care, evaluate outcomes, advocate for the patient, delegate, communicate with the team, etc.

What is the difference between a medical plan of care and nursing plan of care?

Medical plan of care is broad - focuses on the treatment and diagnosis. Nursing plan of care is more holistic - focuses on the patient’s response to the diagnosis/treatment. Addresses the patient’s physical, psychological, social, and functional needs.

What does it mean when a care plan must be SMART?

Specific, Measurable, Achievable, Relevant, and Time-oriented.

What is the daily flow of a Med/Surg RN?

1. Assigned a patient

2. Review their chart

3. RN report

4. Shift Assessments

5. Medication administration

6. Treatment

7. Coordinate care

What are the vital signs and their normal expected ranges?

1. Blood Pressure: SBP 90-100 / DBP 60-80 mmHg

2. Heart Rate: 60-100 bpm

3. Respiratory Rate: 12-20 breaths per minute

4. Temperature: 36-38C (96.8F - 100.4F)

5. PO2: greater than or equal to 95%

What should we do when someone’s vital signs are outside of the normal expected range?

Look at the trend. If they are consistently/normally out of the range, it may not be an emergency.

What are the types of labs?

Admission labs: obtained upon admission to get baseline values

Daily labs: between 5-6AM

Specific labs: various schedules

What are the most common types of labs?

1. CBC (Complete Blood Count): Includes RBCs, Hematocrit/Hemoglobin, Platelets, WBCs, and WBC differentials (Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils)

2. BMP (electrolyte panel): Na, K, Cl, CO2, Ca, Glucose, Creatinine, Blood Urea Nitrogen

3. Liver: AST and ALT (liver enzymes)

4. Albumin

5. Coagulation studies (how long to clot): PT/INR and PTT

What is Clinical Judgement?

Critical thinking put into action. It is active and purposeful thinking, separating relevant and irrelevant information, and being mindful of ADPIE at all times.