PPNC Exam 1

American Nurses Association (ANA)

- Professional organization that represents all registered nurses.

- Develops nursing scope and standards, promotes the rights of nurses, and advances the nursing profession.

International Council of Nurses (ICN)

-Works to ensure quality nursing care, sound health policies, and the advancement of nursing knowledge.

Nurse Practice Act of Florida

-Defines nursing scope of practice in Florida and discusses licensure requirements for RN's

Social Determinants of Health

- Non-medical factors that influence a person's health and well-being

- Economic stability, education access and quality, health care access and quality, neighborhood and home environment, and social and community context

- Help us understand health disparities, equity, and promotion

Health Disparities

Preventable differences in a population's ability to achieve optimal health

Elements of a Community Assessment

-Systematic data collection

- Monitoring health status

-Making info about the community's health available

Elements of a Community

- Structure/Locale: community design and layout, any enviornmental hazards/safety issues

- Population: statistical data (age and sex distribution, growth trends, education)

- Social system: educational, government, communication, and welfare systems

Epidemiology

-Epidemiology: studies the distribution, determinants, and control of diseases or health-related events

How do key components of epidemiological studies inform community-oriented nursing care

-Incidence: tells us frequency; number of new cases that occur within a specific time

- Prevalence: tells us total cases in a population

- Distribution: tells us trends/patterns of health conditions

Characteristics of Vulnerable Populations

- Limited access to healthcare services

- Low socioeconomic status

- Inadequate education

- Lack of social support

- Exposure to environmental hazards

- Higher rates of chronic health conditions

- Language barriers and discrimination/marginalization

Specific Vulnerable Populations

- Homeless/poor individuals

- Immigrants

- Elderly

- Disabled individuals (physically and mentally)

- Abused individuals

Safety Risk Factors based on Developmental Stages

- Neonates and children: drowning, choking, infection

- Adolescents: motor vehicle accidents, other accidental injury, suicide, homicide, substance experimentation

- Older adults: Increased risk of heart disease, cancers, high-risk jobs, negative lifestyle habits, falls

Health Belief Model

- Shows the relationship between a person's health beliefs and health behaviors based on:

- Perceived susceptibility (Ex: i am high/low risk)

- Perceived seriousness ( Ex: it's just the flu, meh)

- Likelihood person will take action (whether due to perceptions or barriers)

-Focus: disease prevention and risk reduction behaviors

Health Promotion Model

- Provides a more comprehensive framework for understanding and promoting health behaviors based on:

- Individual characteristics and experiences

-Behavior-specific cognitions and affect (self-efficacy, potential barriers, benefits of action)

- Behavioral Outcomes (commitment, preferred alternatives, more important demands)

-Focus: overall well-being and positive health outcomes

Maslow's Hierarchy of Needs

- the extent to which people meet their basic needs is a major factor in determining their level of health

Transtheoretical Model of Change

- 5 stages to making a change: precontemplation, contemplation, preparation, action, and maintenance

Hollistic Health Model

- Considers physical, emotional, social, cultural, and spiritual components of health

-Patients are at the center of their own care; empowers the patient to engage in health behaviors

-Focus: integrated wellness.

Internal and External Variables that influence Health

Internal

- Developmental stage

- Intellect

- Emotional state

- Spirituality

External

-Family role

-Social determinants of health

-Cultural background

Levels of Prevention Methods

- Primary Prevention: true prevention, reduces the incidence of a disease (vaccines and seatbelts)

- Secondary Prevention: prevent the spread of disease, illness, or infection once it occurs (screening tests)

-Tertiary Prevention: minimize the effects of long-term disease or disability (physical therapy)

Hospital vs. Community vs. Public Health Nursing

- Hospital: Provides acute care in inpatient settings (individual patients, complex)

-Community: Occurs in community settings (homes, clinics, outpatient centers) and focuses on individuals, families, and small groups

-Public Health: Focuses on improving health of entire populations; emphasizes health promotion and disease prevention

Nursing Process: Assessment

- 1st step of the nursing process

- Comprehensive data collection (Biophysical Psychosocial, Spiritual, and Environmental)

-Subjective data collection through patient interviews (using the 4 C's: Courtesy, Comfort, Connection, and Confirmation)

- Organize and validate your data

What does SHIP stand for?

- Supplies

-Hand Hygiene

- Introduce

- Privacy

STEPPS

- guides communication, improves teamwork, and promotes high-quality safe patient care

- Communication, Team Leadership, Situation Monitoring, and Mutual Support

SBAR

- Situation: what is currently going on with the patient

- Background: why is the patient here/relevant medical history

- Assessment: what do you think the problem is

- Recommendation: what would you do/suggest to correct it

Callout, Checkback, and Handoff

- Call-out: Communicate important or critical info

- Check back: Closed loop communication to ensure that info is understood (ex. repeating a command back)

- Handoff: transfer of info during transition in care

Common Environmental Hazards

- Chemical or Radiation Exposure

- Falls (environmental safety)

- Community Hazards (pollution, violence)

-infectious agents

Environmental Interventions for Fall Prevention in the Hospital

- Handrails in hallways/bathrooms

- Adequate lighting

- Clutter-free, dry floors

- Non-slip mats in showers

- Appropriate bed height

- Accessible call buttons

- Bed alarms for high-risk patients

Environmental Interventions for Fall Prevention in the Home

- Remove/secure throw rugs

- Clear clutter

- Bathroom grab bars

- Improve lighting

- Repair uneven flooring

- Clear pathways

- Non-slip mats in the bathroom

- Staircase handrails

Morse Fall Scale

- Used to evaluate a patient's risk of falling

- The higher the score, the greater a patient's risk of falling

Factors to assess before and during use of physical restraints

- Patient's mental status and cognitive function

- Medical condition, physical limitations, and risk to others

- Potential risks and benefits of restraint use

- Less restrictive alternatives attempted

- Medication effects

- Environmental factors contributing to behavior

- Patient's communication abilities and needs

- Family/caregiver input on patient's history and usual behavior

Physical restraints can lead to which conditions?

- pneumonia

- incontinence

- Pressure ulcers

Alternatives to Using Physical Restraints

- Frequent rounding and monitoring

- De-escalation techniques

- Environmental modifications (reduce noise, adjust lighting, comfort)

- Encouraging family/caregiver presence

- Using bed or chair alarms

- Implementing fall prevention strategies

- Offering relaxation techniques, music therapy, diversional activities

Factors that influence personal hygiene practices

- Family customs

- Media influence

- Cultural beliefs/religious practices

- Self image

- Knowledge of hygiene importance and benefits/risks

- Access to resources/products

- Dependency on a caregiver/ability to perform hygiene procedures

Conditions that place patients at risk for impaired oral hygiene

- Cognitive impairments/physical limitations

- Medical devices (e.g., feeding tubes)

- Side effects of treatments (radiation, chemotherapy)

- Medications that cause dry mouth

- Lack of knowledge about proper oral care

- Inadequate access to oral care supplies

Conditions that place patients at risk for impaired skin integrity

- Immobility

- Excessive moisture (Incontinence, wound drainage, sweat)

- Altered cognition

- Poor tissue oxygenation

- Advanced age

- Decreased sensation

- Obesity

Infection Control

-Set of practices, policies, and procedures designed to prevent and control the spread of infectious diseases within healthcare settings and the community

Infection Control Methods

- Hand hygiene

- PPE

- Proper cleaning and disinfection of environments and equipment

- Aseptic techniques during medical procedures (sterility)

- Isolation precautions for infectious patients

- Surveillance and reporting of infections

- Education and training of healthcare personnel

Correct Order for Donning and Doffing PPE

Donning

- Hand hygiene

- Gown

- Mask

- Goggles

- Gloves

Doffing

- Gloves

- Goggles

- Gown

- Mask

- Hand hygiene

Isolation Categories

- Airborne Precautions

- Droplet Precautions

- Contact Precautions

- Enhanced Contact Precautions

Airborne Precautions

- N95 respirator

- Face shield, gown, eye protection

- Negative pressure room

Droplet Precautions

- Surgical mask

- Gloves

Contact Precautions

- Gown

- Gloves

Enhanced Contact Precautions

- Gown

- Gloves

- Bleach or sporicidal cleaning

Nursing Process: Diagnosis

- Describes a patient's response or vulnerability to health conditions or life events that the nurse is licensed and competent to treat

- Different from a medical diagnosis, which identifies a specific disease, condition, or injury.

- Two vs. Three Part Diagnoses

- Two Part: based on potential problems, includes the condition the patient is at risk for, and the patient-specific etiology (causes)

- Three Part: based on actual problems, includes the condition the patient has, patient-specific etiology, and supporting data

Activity Tolerance

- The type and amount of exercise or work a person can perform without undue exertion or injury.

Exercise Pattern

- An individual's normal daily activity and exercise routine

- includes the type, frequency, intensity, and duration of physical activities they regularly engage in.

Range of Motion (ROM)

- The full movement potential of a joint, from full flexion to full extension

- important measure of joint health and mobility

Developmental Factors that Influence Mobility

- Neurological development (motor control)

-Nutritional Status

- Loss of bone mass, density, and strength with age

- Once reaching later adulthood, slower walking and coordination

Safe patient handling and early mobility practices

- Implementing mechanical lift devices and transfer equipment

- Proper posture when positioning patient ( legs are not back, bend knees and hips, not waist, body is in front of the patient, grab from behind thighs and shoulders)

- Use of assistive devices (gait belt)

- Administering analgesics before mobility if necessary

Safe and effective transfer techniques

- Assess the patient and situation (mobility status, mental state)

- Plan the transfer (method and equipment)

- Prepare the environment (safety)

- Use proper body mechanics

- Utilize assistive devices (lifts, gait belts)

- Execute the transfer

- Monitor throughout

- Document the transfer

Safety Measures for use of Assistive Devices

- Properly size the device to the patient

- Teach correct posture, grip, and how to navigate obstacles

- Practice proper gait pattern in a safe environment

- Gradually increase walking distance as tolerated

Assistive Devices

- Canes

- Walkers (not used for balance issues)

- Gait Belts (only tool used for balance)

- Wheelchairs

Gait Belt

- Used for stability

- Allows the nurse to direct patient's movement

- Not for pulling or lifting

Fowler's and Semi Fowler's

Fowler's: HOB 45-90 degrees

- Lung expansions and good for difficulty breathing

- Feeding

Semi-Fowler's: HOB 30-45 degrees

- Comfort

- Reduces aspiration

Lateral, Prone, and Supine

- Lateral: on side (recommended every 2 hours)

- Prone: on stomach (rarely used)

- Supine: on back (prevents shearing)

SIMS

- on left side, left knee up, tilted on chest

- for enema, rectal temp, and pregnancy

Active Range of Motion Exercises

- Patient performs exercises independently

- Nurse provides instructions and ensures proper technique

Passive Range of Motion Exercises

- Nurse performs all movements for patient

Active Assisted Range of Motion Exercises

- Patient initiates movement

- Nurse provides assistance

- Useful for patients with limited strength or endurance

Venous Thromboembolisms

- DVT: clot in deep vein, usually in the lower leg

- PE: clot in the lungs due to deep clot breaking loose

Prevention of VTE (DVT and PE)

- Nurse's Role: Early ambulation, ROM exercises

- Physician ordered interventions: coagulants, compression devices (SCD's), and deterrent socks (TED hose)

Risk factors for pressure injury formation

- Impaired sensory perception

- Impaired mobility

- Decreased level of consciousness

- Shear

- Friction

- Moisture

- Incontinence

Shear Force vs. Friction

- Shear force: sliding movement of skin and subcutaneous tissue while the underlying muscle and bone are stationary.

- Friction: force of 2 surfaces moving across each other

Stage 1 Pressure Injury

- Non-blanchable erythema of intact skin

- Silicon foam pads used for prevention and treatment

Stage 2 Pressure Injury

- Partial-thickness skin loss with exposed dermis

- Ex. open sore or blister

Stage 3 Pressure Injury

- Full-thickness skin loss with exposed adipose

- May look like a crater

Stage 4 Pressure Injury

- Full-thickness skin and tissue loss

- Visibly see bone or tendon

Deep tissue injury

- Purple/maroon color, similar to a bruise

- Evolves over time

- Patient may or may not recover

- Typically over a bony prominence

Unstageable pressure injury

- Covered by eschar/slough, unable to classify

Braden Risk Assessment Scale

- Used to measure risk for pressure ulcers in patients

- The lower the score, the higher the risk for a pressure ulcer

Other Skin Integrity Scales

- PUSH: measures healing of wounds

- Norton Scale: risk for pressure injury (similar to Braden, lower score = higher risk)

Guidelines for Hot and Cold Therapy

Hot Therapy: Tight muscles, stiff joints, pinched nerves, muscle pain, arthritis discomfort, causes vasodilatation

- Typically 15-20 minutes

Cold Therapy: Sprained, broken bones, causes vasoconstriction

- Usually 10-15 minutes

Wound Healing: Primary Intention

- actual surgical incision that an advanced healthcare provider is going to suture

- low risk infection

Wound Healing: Secondary Intention

- Wound edges are not approximated, so wound is left open

- For dirty wounds, leaking wounds, etc

- Wound is healing from the bottom up

- Higher risk infection

Wound Healing: Tertiary Intention

- Wound is deliberately left open, then it is surgically sutured/closed

- Highest Risk Infection

Types of Exudates

- Serous: clear, watery plasma

- Purulent: thick, yellow, green, tan, or brown (scab, infection)

- Serosanguineous: pale, pink, watery; mixture of clear and red fluid

- Sanguineous: bright red; indicates active bleeding

Nursing Process: Planning:

- Generate solutions and outcomes to reduce risks of injury

- Use SMART Goals: Specific, measurable, attainable, realistic, TIME FRAME!

- Planned interventions can be independent (autonomous, initiated by the nurse) or collaborative (require a provider's order)

Granulation tissue

- Pink, beefy-red tissue, indicates healing

Slough

- Yellow/green tissue covering wound, by-product of inflammatory wound healing

Eschar

- Black necrotic tissue

Exudate

- All types of drainage

Tunneling

- Narrow wound tract

- it stops at one point

Undermining

- Separation beneath skin surface