WVU NSG 212 Final

Continuity of Care

Continuation of care smoothly from one provider to another, so that the patient receives the most benefit and no interruption in care.

Stages of Nursing Process

ADPIE
-Assessment
-Diagnosis
-Planning
-Implementation
-Evaluation

Nurses Role in admission

-room assignment (fall risk, infection control)
-ID of patient and any risks on wristband (fall, allergies, etc)
-Thorough assessment
-Review advanced directives
-Diagnostic testing
-obtain necessary consents
-Implementation of providers orders
-PATIENT TEACHING IS ONE OF YOUR TOP PRIORITIES

nurses role in discharge

-type of discharge (ordered by physician, AMA)
-actual date and time of discharge, who accompanied client, and how client transported
-where was the client discharged (home, facility)
-a summary of clients condition at discharge
-any unresolved difficulties and plans for follow up
-dispositions of valuables, meds from home
-copy of clients discharge instructions

Nurses role in transfer process

-continuity of care
-info sharing

Concepts of AMA

-against medical advice
-legally free to leave
-choice carries a risk for increased illness and complications
-Pt must sign release form
-pt is informed of risks prior to signing
-pt signature must be witnessed
-form become part of medical record

SBAR

S: Situation
B: Background
A: Assessment
R: Recommendation

SBAR (Situation)

What is the situation you are calling about?
• Identify self, unit, patient, room number.
• Briefly state the problem, what is it, when it happened or started, and how severe.

SBAR (Background)

Pertinent background information related to the situation could include the following:
• The admitting diagnosis and date of admission
• List of current medications, allergies, IV fluids, and labs
• Most recent vital signs
• Lab results: provide the date and time test was done and results of previous tests
for comparison
• Other clinical information
• Code status

SBAR (Assessment)

state pertinent assessment findings obtained with interpretation of data

SBAR (Recommendation)

what do you recommend for the patient (any bleeding precautions, fall risks, skin integrity interventions, lab tests, medication, etc)

Factors that affect Urination

age, environmental factors, medication hx, psychological factors, muscle tone, fluid balance, current surgical or diagnostic procedures, presence of disease conditions
-caffein and alcohol = increase
-high sodium = decreases

Med affects on urination

-diuretics prevent reabsorption of water
-antihistamines and anticholinergics = urinary retention
-chemo= toxic for kidneys
-phenazopyridine = orange, red
-amitriptyline = green-blue
-levodopa = dark
- riboflavin =bright yellow
-roughly 30 mL/hr = 720 mL/day

Alterations in Urinary Function

-polyuria (diuresis) = abnorm large amount 2500 mL/day
-oliguria - less than 500 mL/day
-anuria - less than 100 mL/day
-nocturia = freq at night
-urgency = immediate
-dysuria = painful/difficult
-maturational enuresis = involuntary urinations after 4-5 yrs old.
-urinary retention = inability to fully empty

Concepts of age related changes to urinary elim

-bladder control by 4-5 yrs old
-prostate enlarges after 40 yr = freq, retention, inc, UTI
-childbirth and gravity
weaken of pelvic floor
Kegel exercises strength
-preg
fetus compression the bladder
-older adults
fewer nephrons
loss of muscle
nocturia
inefficient emptying

Nursing interventions and diagnosis for alterations in urinary function

diagnosis
-impaired urinary elim
-inc
-urinary retention

interventions
-promote normal habits
-fluid intake
-kegal exercises
assistance with bathroom
care for devices (foley)
foley or cath

Assessment of fluid balance

I&O
-output cannot equal input because of absoprtion
-roughly 2400 mL/day
-measureable

DW
-most accurate assessment of fluid balance
-same time
-gain or loss greater than 1lb = mostly fluid

Lab work related to renal disease

-Bun = 5-20
blood urea nitrogen
urea final product of protein metabolism
bun measure the nitrogen portion of urea
-GFR or EGFR
estimated glomerular filtration rate
few mL/min to 200mL/min
normal is greater than or equal to 90 mL/min
-Creatinine (Cr) overall 0.6-1.2
men 0.9-1.3
women 0.6-1.1
child 0.3-1.0

Renal Failure Stages

Normal = > than or = to 90 with no kidney damage

Stage 1: > or = to 90 with kidney dam

Stage 2: 60-89

Stage 3: 30-59

3a. 45-59

3b. 30-44

Stage 4: 15-29

Stage 5: Kidney failure (GFR < 15=dialysis)

Lab work r/t alterations in urinary elim

lab urine tests

-culture - UTI (RBC, WBC, micro)

-sensitivity - ID drug for treatment

Urine specific gravity

-normal = 1.015-1.025

-the lower = over hydration (HOLD Fluids)

-the higher = dehydrated(PUSH Fluids)

urinalysis

clean catch

cath urine specimen

24 hr urine

Beside sonography

-with bladder scanner, noninvasive portable ultrasound
-measures bladder volume + residual volume after urination

kidneys, ureters, and bladder (KUB)

xray that determines size, shape and position

intravenous pyelogram

-contrast injected
-views ducts, renal pelvis, ureters, bladder + urethra

renal scan

renal blood flow and anatomy of kidneys

renal ultrasound

gross renal structures with high freq waves

cyloscopy

lighted instrument

urodynamic testing

test bladder muscle function

indwelling cath

- double lumen (foley)
-indwelling cath cannot = urinary retention

indwelling foley

-catheter remains in place (within client) for period of time

coude cath

-has a bend
Used for males with prostate complications BPH- benign prostatic hypertrophy(enlarged prostate)

caring for a pt receiving hemodialysis

-question pt presense
-inspect
-palpate for feel of thrill
-auscultate for bruit

stress inc

-loss of small amounts from increased abdominal pressure
-laughing, sneezing, lifting
-Ex- pregnant

urge inc

the loss of urine in response to a sudden, urgent need to void; the person cannot get to a toilet in time

overflow inc

-urinary retention from bladder over-distention + freq loss of small amounts
-obstruction of the urinary outlet
-ex - no feeling

reflex incontinence

-loss of a mod amount of urine without warning
-due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction

emptying of the bladder without the sensation of the need to void

functional inc

cognitive, mobility, and environmental barriers

total inc

unpredictable, no treatment

UTIs

-more common in women, diabetics, and elderly
-nephritis = infection spread from bladder to kidneys
S/S
-pain when urinating
-freq
-blood
encourage fluid intake + cranberry juice and wear cotton underwear, no tight pains, shower, fluids, void

meds to treat UTIs

antibiotics
-gentamicin
-cephalexin
-trimethoprim/sulfamethoxazole

tricyclic antidepressants
-nortriptyline(has anticholinergic effects to help relieve inc)

urinary antispasmodics or anticholinergic agents
-oxybutynin and Dicyclomine(decrease urgency and alleviates pain)
-phenazopyridine (bladder analgesic treats the manifestations or spasm of UTIs, turns urine orange)

Urinary Diversons

=cannot void normally
-lleal conduit
-suprapubic cath
-continent urostomy
-nephrostomy
-neobladder

lleal conduit

-segment of ileum revised as bladder with ureters connected
-abdominal stoma - external pouch, drains constantly

suprapubic cath

-large foley/mushroom inserted through abdominal wall above symphysis pubic into bladdrr
-closed drainage system

continent urostomy (Koch Pouch)

small intestines made into artificial bladder pouch—need to catheterize regularly via I and O cath ( via the self-contained stoma)

nephrostomy

-inc urinary diversion
-attaches tube from renal pelvis via a stoma to the surface of the abdominal wall

neobladder

-new bladder created
-using the ileum that attaches to the ureters and urethra
-maintain continence, learns to void by straining

normal and abnorm of bowel elim

1 or more x/day to 2-3x/week

breastfed babies

-more freq
-yellow to golden
-loose
-little odor
-could contain cords/muscus
-control by 30 months

formula fed infants

-yellow to brown
-paste-like
-stronger odor
-2-4x/day
-could contain cords/mucus
-control by 30 months

constipation

chronic problem for older adults

nursing interventions for GI functioning/elim

-promote reg pattern
-meds
cathartics, suppositories
se of conservative methods 1st like mobility food, fluids
anti diarrheals
enemas
-digital removal of impact
-bowel training program
-food and fiber
fiber = 25+30g/day

EGD

esophagogastroduodenoscopy
-visual exam of esophagus, the stomach, and duodenium

Colonoscopy

visual examination of the large intestine from the anus to the ileocecal valve

sigmoidoscopy

visual exam of sigmoid colon, rectum, and anal canal

lleostomy

-liq drainage
-minimal odor
-more freq emptying
-very acidic

ascending colostomy

-liq
-acidic
-odor
-freq

transverse

-odorous
-mushy draniage

descending

-solid
-regulated
-odor
-most normal

ostomies

large or small intestine

colostomies

end of colon

ileostomies

end in the ileum

end stomas

-permanent
results of colorectal cancer or bowel disease

loop colostomies

-resolve med emergency
-temporary
-proximal stoma = stool
-distal stoma = mucus

double barrel colostomies

-proximal =stool
-distal = inactive intestine
-temporary

ostomy care

-stable 4-6 weeks
-keep skin around stoma clean and dry
-observe site and use clean tech
-empty bag when 1/3 - 1/2 full
-burp bag
-avoid "gassy foods" like leafy veg, kale, spinach, cabbage, lettuce
-use yogurt, cranberry juice to decrease odor

Vagus nerve stimulation

-Valsalva
bears down
decreases VF to atria and ventricles = decreased HR
HT
Syncope
not recommended with cardiovascular

chain of infection

infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host

Contact precautions are used for what

VRE, MRSA, C. Diff, herpes simplex, scabies, and Varicella zoster

practices used to prevent spread of disease by direct or indirect contact

Droplet precautions are for what

All meningitis and all influenza
Pertusis, Diptheria, Mumps, All Meningitis

Must be followed for a patient known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking, or laughing.

Airborne precautions are for what 4 diseases?

SARS (Severe Acute Respiratory Syndrome), TB, Measles and Varicella

Methods of infection control that must be used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei.

Standard Precautions

A strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.

used for everyone

medical asepsis

practices designed to reduce the number and transfer of pathogens; synonym for clean technique

surgical asepsis

techniques used to destroy all pathogenic organisms, also called sterile technique

-above waist
-dont turn back
-no cough sneeze
- 1 in border
-6 inches above
-dont reach across

what may indicate infecton?

-increased WBC
normal is 5,000=10,000

-increased ESR
presence of pathogen in urine, blood, sputum, or draining cultures

HAIs

healthcare associated infections

-Cath associated urinary tract infection
-surgical site infection
central line associated bloodstream infect
-ventilator associated pneumonia

age related changes that relate to infection

elderly
-Temp and WBC wont elevate
-decreased inflammatory and immune response
-agitation, confusion, inc

Stages of infection

Incubation period
Prodromal stage
Full stage of illness
Convalescent period

incubation period

interval between initial infection and first signs and symptoms

prodromal stage

person is most infectious, vague and nonspecific signs of disease

full stage of illness

specific signs and symptoms

convalescent

recovering from illness

s/s of infections

1. Fever

2. Increased pulse and respiration, decreased BP

3. Pain or tenderness at the site of infection

4. Fatigue

5. Loss of Appetite

6. Nausea and vomiting

7. Diarrhea

8. Rash or sores

9. Redness and/or swelling at the site

10. Discharge of drainage from the site

potential treatments for infection

antipyretics
-fever + discomfort
antimicrobial therapy
-kills/stops growth of micro org
anthelminthics
-worm infestations

risk factors for developing an infection

1. Health of the individual
2. Age of the person
3. Heredity
4. Pre-existing conditions such as HIV
5. Strength of the pathogen

immunocompromised

having an immune system incapable of responding normally and completely to a pathogen or disease

host suceptibility

specific immunity, genetics, antibodies, lifestyle

exogenous

Produced outside the body

endogenous

Produced within the body

how to prevent HAIs

freq and proper hand hygiene practice
-avoid electronic equipment
disinfect all equip
-barrier contact precautions
-private rooms

multi drug resistant infections

-MRSA (Methicilin-resistant Staphylococcus aureas)

-VRSA (Vancomycin-resistant Staphylococcus aureas)

-VRE (Vancomysin-resistant enterococci)

-ESBLs (Extended spectrum beta-lactamases

-C-Diff (Clostridium dificil)

-CPE

-MUST USE BLEACH TO DECONTAMINATE

-MUST WASH WITH SOAP AND WATER

native immunity

Restricts entry or immediately responds to a foreign organism through the activation of phagocytic cells, complement, and inflammation

passive immunity

the short-term immunity that results from the introduction of antibodies from another person or animal.
-breast milk, placenta

active immunity

A form of acquired immunity in which the body produces its own antibodies against disease-causing antigens.

portals of exit

respiratory tract,
-mycobacterium tuberculosis + streptococcus pneumoniae
-TB

gastrointestinal tract
-shigella, salmonella enteritis, salmonella typhi, Hep A

genitourinary tract
-E coli, Hep A, HSV, HIV

skin
-HSV, varicella

blood
-HIV and Hep B + C

illness vs disease

Illness
-refers to experiences of disvalued changed in state of being and social functioning
-refers to the person's perception, experience, expression and pattern of coping with symptoms
-the big picture
-can occur in the absence of disease (conversion disorder)

Disease:
-objectively measurable anatomic deformations and pathophysiological sates that may be cause by various factors
-refers to the way that practitioners recast illness in terms of their theoretical models of pathology
-more narrow way of thinking

Acute vs Chronic illness

- Acute Illness: short term, appear suddenly, subside quickly, may not require medical attention (COPD flare up or Flu)
-goal is to cure/correct
- Chronic Illness: usually cannot be cured, develop gradually, require continuous medical attention, may be lifelong (COPD or cancer)
-goal is to manage, control, and minimize

Suchman Illness stages

-experiencing symptoms
-assume sick role (significant to seek help)
-assume dependent role (accept diagnosis and plan)
-achieving recovery/rehab (resume normal)

Primary prevention

directed towards promoting health and preventing the development of disease processes or injury

-ex immunization clinics

Secondary prevention

focus on screening for earl detection of disease with prompt diagnosis and treatment of anything found

Tertiary prevention

begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate pts to a maximum level of function

Models of Health Promotion

Health Belief Model (Stretcher & Rosenstock)
Health Promotion Model (Pender)
Transtheoretical Model (Prochaska & DiClemente)
The health-illness continuum
The agent-host-environment model (Leavell &Clark)