Savannah focused assesment

Code of Ethics for Nurses

ANA guidance addressing nursing conduct, client privacy, professional behavior, and protection of clients and the nursing profession.

Beneficence

The ethical obligation to benefit the client, minimize harm, and provide care that promotes well-being.

Nurse Practice Act

State-specific laws and regulations that define the scope and standards of licensed nursing practice and protect client safety.

What are the elements of informed consent?

Disclosure, comprehension, competence, and voluntariness.

Theory

A group of concepts that describes a pattern of reality and can be tested, changed, or used to guide research.

Concept

An abstract idea or impression used to describe objects, properties, events, and relationships.

Conceptual Framework/Model

A group of related concepts organized into an understandable pattern.

Deductive Reasoning

Reasoning that begins with a general idea or principle and applies it to a specific situation.

Inductive Reasoning

Reasoning that begins with specific observations or situations and develops a general conclusion.

What are the six components of the chain of infection?

Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.

Health

A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Wellness

An active state of being healthy and living a lifestyle that promotes physical, mental, and emotional well-being.

What human dimensions affect health and wellness?

Physical, emotional, intellectual, environmental, and sociocultural dimensions.

High-Level Wellness Model

A model emphasizing functioning at one's maximum potential physically, mentally, and emotionally; a person may experience wellness regardless of current health status.

Health Belief Model

A model based on a person's beliefs and perceptions about health, including perceived susceptibility, seriousness, benefits of action, and barriers to action.

Health Promotion Model

A model describing how people interact with their environment while pursuing health, considering personal experiences, beliefs, self-efficacy, barriers, and situational influences.

What preparation may be needed for an X-ray?

Remove clothing and jewelry from the area being examined. Contrast or NPO status may be required depending on the study. A chest X-ray may require a deep breath and breath hold.

CT Scan

A noninvasive radiographic procedure that uses X-rays and computer processing to create cross-sectional images of the body from multiple angles.

What preparation is needed for angiography?

Verify informed consent, assess allergies, review BUN and creatinine, follow NPO instructions, and teach that contrast may cause warmth, flushing, or a metallic taste.

Cognitive-Perceptual Pattern

Includes sensory function, memory, attention, learning, pain perception, judgment, consciousness and orientation, language, and neurologic perception.

What factors affect body temperature?

Circadian rhythm, age, gender, physical activity, health status, and environmental temperature.

Remittent Fever

A fever in which the temperature fluctuates but does not return to normal.

Sustained/Continuous Fever

A fever in which the temperature remains above normal with minimal variation.

Relapsing/Recurrent Fever

Fever episodes separated by one or more days of normal temperature.

Pulse

The palpable pressure wave produced by each heartbeat, measured as the number of beats felt over a peripheral artery in 1 minute.

How does the autonomic nervous system affect pulse?

Parasympathetic stimulation decreases heart rate, while sympathetic stimulation increases heart rate.

Systolic Pressure

The maximum arterial pressure produced when the left ventricle contracts.

Pulse Pressure

The difference between systolic and diastolic blood pressure.

Inspection

An assessment technique using observation to evaluate characteristics such as size, color, shape, position, and symmetry.

Palpation

An assessment technique using touch to evaluate temperature, turgor, texture, moisture, vibrations, tenderness, and shape.

Percussion

An assessment technique used to evaluate the location, size, shape, and density of underlying tissues and organs.

Petechiae

Small, pinpoint hemorrhagic spots caused by capillary bleeding.

What is assessed in the thorax and lungs?

Health history and risk factors plus inspection, palpation, percussion, auscultation, and posterior chest expansion.

What are the normal breath sounds listed in the slides?

Bronchial or tubular, bronchovesicular, and vesicular breath sounds.

What four characteristics are described during auscultation?

Pitch, loudness, quality, and duration.

What cardiovascular/peripheral vascular changes are common in older adults?

Apical and distal pulses may be harder to palpate, proximal arteries may dilate, vessels may become prominent or tortuous, varicosities may occur, blood pressure may increase, and pulse pressure may widen.

What is the correct sequence for abdominal assessment?

Inspection, auscultation, percussion, then palpation.

In what order are bowel sounds auscultated in the course slides?

RLQ, RUQ, LUQ, LLQ.

What are the six QSEN competencies?

Patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

What is the focus of a safety assessment?

The person, the environment, and specific risk factors.

Cultural Competency

The ability to provide care that respects and appropriately responds to a client's cultural beliefs, values, practices, and needs.

Life Dimension

An aspect of a person's life and well-being, such as physical, emotional, intellectual, environmental, or sociocultural functioning.

How are Functional Health Patterns used in nursing?

They provide an organizing framework for assessment and nursing care.

Assault

An intentional act that creates fear or apprehension of harmful or unwanted contact.

Malpractice

Professional negligence by a licensed health-care provider.

Standards of Care

The expected minimum level of safe and competent practice used to evaluate nursing actions.

Quality Assurance

Activities used to evaluate whether care meets established standards and to identify ways to improve quality.

What are examples of physical safety hazards?

Falls, suffocation, poor body mechanics, sensory dysfunction, poor nutrition, and improper heat or cold applications.

What are examples of psychological safety concerns?

Client identification, privacy, confidentiality, patient rights, cognition, and perception.

What should a nursing safety plan consider across the lifespan?

The client's developmental stage, individual risk factors, environment, and appropriate prevention strategies.

What organizational frameworks are listed for nursing assessment?

Functional Health Patterns, head-to-toe assessment, and body-systems assessment.

What does the Health Perception-Health Management Pattern describe?

The client's perception of overall health and well-being and adherence to preventive health practices.

What does the Value-Belief Pattern describe?

Values, goals, beliefs, and spiritual or religious factors that guide choices and decisions.

What life dimensions are emphasized in the lifespan objectives?

Sociocultural, spiritual, developmental, physiologic, and psychological dimensions.

What developmental concepts are included in the lifespan objectives?

Family development, human development, and principles of growth and development.

What dimensions should be assessed when comparing adults across the lifespan?

Physiologic, developmental, spiritual, psychological, and sociocultural characteristics.

What nursing-diagnosis areas are listed under Health Perception-Health Management?

Therapeutic regimen management, health-seeking behaviors, risk for injury, and developmental considerations.

What theoretical models of health are listed in the Health-Wellness-Illness objectives?

Health Belief Model, High-Level Wellness Model, and Holistic Health Model.

What wellness-nursing activities are emphasized in the course objectives?

Health promotion, illness prevention, communication, health education, and nursing diagnoses.

What is the heart-auscultation sequence in the Week 3 checklist?

Aortic area, pulmonic area, Erb's point, tricuspid area, then mitral area.

What vascular structures are auscultated for abdominal bruits in the Week 3 checklist?

The abdominal aorta, femoral arteries, and iliac arteries.

Logrolling

Turning a client as one unit while maintaining alignment of the head, neck, spine, hips, and legs.

What are the major purposes of a nursing assessment?

To collect and validate health information, identify actual and potential problems, establish a baseline, guide nursing care, and evaluate changes over time.

What is the difference between a medical assessment and a nursing assessment?

A medical assessment focuses mainly on diagnosing disease or pathology; a nursing assessment focuses on the client's responses, functional status, risks, needs, and nursing problems.

What is a general survey?

An overall observation of the client's appearance, behavior, mobility, level of consciousness, body structure, and general condition.

Why are lifespan considerations important in health assessment?

Normal findings, developmental expectations, communication needs, positioning, and safety concerns vary with age.

Bronchial/Tracheal Breath Sounds

Loud, high-pitched breath sounds normally heard over the trachea and larynx.

Bronchovesicular Breath Sounds

Medium-pitched and medium-intensity breath sounds normally heard over the major bronchi.

Vesicular Breath Sounds

Soft, low-pitched breath sounds normally heard over most peripheral lung fields.

Wheeze

A high-pitched, musical adventitious breath sound caused by narrowed airways.

Rhonchi

Low-pitched, coarse or gurgling breath sounds often associated with secretions in the larger airways.

Crackles

Discontinuous popping or crackling sounds often associated with fluid or reopening of small airways.

Pleural Friction Rub

A grating or rubbing sound caused by inflamed pleural surfaces rubbing against each other.

What is a widened pulse pressure?

An increased difference between systolic and diastolic blood pressure.

What does neurovascular assessment evaluate?

Circulation, motor function, and sensation.

What circulation findings are important in neurovascular assessment?

Peripheral pulses, capillary refill, skin color, temperature, swelling, and pain.

What motor findings are important in neurovascular assessment?

Ability to move the extremity, muscle strength, and presence of weakness or paralysis.

What factors can affect safety across the lifespan?

Developmental level, mobility, cognition, sensory function, environment, medications, illness, lifestyle, and individual risk factors.

What is altered function?

A change from normal or previous physical, mental, or social functioning related to illness or disease.

Nursing

A highly specialized profession that combines scientific knowledge with the art of caring; nurses provide care independently and collaboratively with the health-care team.

American Nurses Association (ANA) Definition of Nursing

Protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering; and advocacy for individuals, families, communities, and populations.

Nursing in Nursing Theory

The professional actions and care provided to support the person and promote health.

Functional Health Patterns

Gordon's framework used to organize assessment information about a person's health patterns.

Nursing Professionalism

Professional nursing involves evolving knowledge, scientific skills, caring, independent and interprofessional practice, collaboration, supervision, and research.

Nurse Roles

Nurses provide care, collaborate with the health-care team, serve as preceptors or supervisors, advocate, educate, coordinate care, and participate in research.

Associate Degree Nurse Entry Competencies

Provider of care, manager of care, and member of the discipline of nursing.

Practical/Vocational Nursing Education

Basic nursing education that prepares practical or vocational nurses to practice within their defined scope of practice.

Community-Based Nurse

A nurse who provides health promotion, manages acute and chronic illness, promotes self-care, and helps maintain continuity of care.

Qualities of a Community-Based Nurse

Knowledgeable and skilled, independent in decision-making, and accountable.

Discharge Planning

A coordinated process that identifies needs, establishes goals, teaches the client and family, arranges referrals, and evaluates the effectiveness of the plan.

Formal Discharge Planning/Referral Indicators

Lack of treatment knowledge, social isolation, new chronic disease, major surgery, prolonged recovery, emotional or mental instability, complex home care, financial difficulty, lack of referral resources, or terminal illness.

Privacy

Protection of a client's personal space and personal information from unnecessary intrusion.

Patient Rights

Rights nurses must respect and protect, including participation in care decisions, privacy, safety, and access to health information.

Just Culture

A safety approach focused on learning and improving systems while distinguishing human error from reckless behavior.

Legal Safeguards for Nurses

Maintain competence, practice within legal boundaries, follow policies, evaluate assignments, keep knowledge current, respect client rights, document carefully, and work within organizational policies.

OSHA Nursing Relevance

Workplace safety regulations affecting areas such as electrical equipment, isolation techniques, radiation exposure, and hazardous chemicals.

Nursing Organizations

Organizations that support nursing practice, education, professional development, advocacy, standards, and the nursing profession.

Chain of Infection

The sequence of infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.

Older Adult Physiologic Areas

General status, integumentary, musculoskeletal, neurologic, special senses, cardiopulmonary, gastrointestinal, dentition, and genitourinary systems.

Culturally Competent Nursing Care

Care that demonstrates self-awareness, knowledge of the client's culture, respect for differences, and avoidance of judgmental attitudes.