foundations unit 3 exam

policy

an action taken to address an issue, the product, and the process by which this happens

ANA code of ethics

establishes ethical standards for the profession of nursing

- define ethical nursing practice and professionalism

- obligations and professional ideals

acuity

how sick a patient is and how much care they will require

how much care is involved

HIPAA

protects individual health insurance coverage

- protects health info

- applies to all forms of health info

EMTALA (federal)

prevent "patient dumping"

ensures that any individual presenting to an ED will recieve med attention

- 250 yd zone

- cant just transfer someone

prohibits the transfer of pts without appropriate SCREENING AND STABILIZATION

patient self determination act

requires all health care orgs to inform pts of their right to make decisions regarding their care

- right to refuse

- document education and get pt to sign form

advance directives

written documents outlining the wishes of the person in the event they cant make decisions for themselves

nasal cannula

1-6 L

safe and easy

can talk/eat w it

may irritate

dry nose-> add humidifier

may rub ears

facemask

easily moveable

less restrictive then cpap and bipap

can be difficult to talk/eat

can feel smothering

- 5-10L

- 40-60%

CPAP

continuous positive airway pressure

must be TIGHT to their face

BiPAP

positive and negative pressure

last resort! pts hate it

only tolerate for a short time

TIGHT to face

cant eat/drink/talk

ventilators

pts can become dependent

- often sedated

- after 10-12 days tube irritates -> trach placed

tracheostomy

long term - pts can go home w this

- can be hooked up to vent OR may breathe by self

non rebreather mask

15L (60-90%)

high o2

cant talk

get the most 02

incentive spirometer

promotes full expansion of chest/lungs

prevent infection

ordered by MDs

a goal is set

pts need to be taught

huff cough

shakes loose debris

purse lip breathing

allows dead air/co2 to escape

frees up space in lungs for increased ventilation

tripod breathing

sit up and leaning over bedside with pillow on it -> increased ventilation

cognitive learning

thinking

"brain"

psychomotor learning

skills

performing skills

demonstration and return demonstration

- teach back

affective learning

involved attitudes, feelings, beliefs, emotions

- includes recieving and responding to new ideas

- changes in feelings, etc

teach back method

the BEST way

reduce medical errors and misunderstandings

use OPEN ended questions

patient teaching

formal

informal (one on one, casual)

self directed (pts take responsibility for their own learning)

EBP

use of info from research and other sources to determine safe and effective nursing care

- application

research

systematic inquiry answers questions, solves problems, contributes to knowledge base of nursing

- discovery

quality improvement

improves local work processes to improve pt outcomes and health system efficiency

- evaluation

PICOT questions

P = patient population of interest

I = Intervention of interest

C = comparison of interest

O = outcome

T = time

Levels of evidence

bottom is worst (opinions)

top is the best (systematic review, meta analysis)

ethics

the study of conduct and character

- what is good or valuable for individuals and society at large

values

personal beliefs about the worth of a given idea, attitude, custom, etc that sets standards that influence behavior

autonomy

patients being able to make own decisions

- linked to patient self determination act

ex. DNR, informed conset, nurse witnesses signature and asks if they understand

beneficence

more benefit then pain

taking positive action to BENEFIT the pt

- benefits must outweigh risks

- ex chemo - hair loss but save life

nonmaleficence

first do no harm, avoid harm

non harm, requires nurses to do no harm

- ex. wash hands, do not do things that you have not been trained for

justice

- fairness

- treating everyone the same

(whos the sickest?

fidelity

doing what you say you are going to do, being faithful and keeping promises

- ex. come back and check on pts when u say you will

veracity

telling the truth

not telling white lies

- ex admitting mistakes

professional nursing code of ethics

a set of guiding principles that all members of a profession accept

- advocacy: use your skills for the benefit of others

- responsibility: respect ones professional obligations

- accountability: answering for your own actions

- confidentiality: respect pt privacy

moral distress

the anguish experienced when a person feels unable to act according to a closely held core value

ex. continuing life

- can go to an ethical board

legal limits of nursing: sources of law

1. constitutional law

2. statutory law (civil law, criminal law)

3. administrative law

patient protection and affordable care act (federal)

consumer rights and protections

- helps pts w healthcare access

- increased access to care

Americans with disabilities act (ADA)

protects rights of people with physical/mental disabilities

ex. ramps, braille

protection against discrimination

must provide accomodations

patient self determination act

must educate staff and pts

- provide pts w info on their rights

allows them to make decisions abt their care

they have the right to refuse treatment and to formulate an advance directive

nurse practice acts (state)

licensure

nurse licensure compact

good samaritan laws

limit liability and offer legal immunity if a nurse helps at the scene of an accident

- has to be volunteering

- can not get paid

torts

civil wrongful acts or omissions of care made against a person

quasi intentional torts

acts in which a person may not intend to cause harm to another but does

- person didnt mean to cause harm, but did

unintentional torts

person is harmed and the person inflicting the harm knew or should have known

intentional torts

assault

battery

false imprisonment

assault

threatening behavior

threats

" i will restrain u"

battery

physical touching that may or may not cause harm but may cause distress

false imprisonment

restrain a client

4 side rails

defamation

false statements that result in damage to reputation

slander

verbal!

speech/spoken

libel

written

4 steps of malpractice

1. the nurse had a duty

2. nurse didnt carry out duty

3. harm was done as a result of this gap

4. damages/remedies are allowed under law

malpractice

type of negligence

person being held liable must be a professional