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Asepsis

All activities used to prevent infection or break the chain of infection.

What does scope of practice describe?

What the nurse does, the nurse's responsibilities, where and when care is performed, and why and how care is achieved.

Code of Ethics for Nurses

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

Autonomy

Respecting the client's right to make their own health-care decisions, including the right to refuse care.

Beneficence

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

Nonmaleficence

The obligation to do no harm.

Veracity

The obligation to provide truthful and accurate information.

Fidelity

The obligation to demonstrate loyalty, keep promises, and uphold commitments.

Justice

Providing fair, impartial, and equitable care and allocation of resources.

Nurse Practice Act

State-specific law/regulatory framework establishing definitions, rules, and regulations for licensed nursing practice and client safety.

Tort

A civil wrong committed against another person or that person's property.

What are examples of intentional torts?

Assault and battery, defamation of character, invasion of privacy, false imprisonment, and fraud.

What are the four elements of liability?

Duty, breach of duty, causation, and damages.

What are common categories of malpractice claims?

Failure to follow standards of care; use equipment responsibly; assess and monitor; communicate; document; advocate; or follow the chain of command.

What are the elements of informed consent?

Disclosure, comprehension, competence, and voluntariness.

What rights does HIPAA give patients regarding their health record?

Rights include seeing/copying the record, requesting updates/corrections, obtaining certain disclosure information, requesting restrictions, and choosing how health information is received.

Theory

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

Concept

An abstract impression organized into a symbol of reality that describes objects, properties, events, and relationships.

Conceptual framework/model

A group of concepts organized into an understandable pattern.

Deductive reasoning

Starts with general ideas and considers specific actions or ideas.

Inductive reasoning

Builds from specific ideas or actions to conclusions about general ideas.

General systems theory

Breaks whole things into parts to understand how the parts work together in systems.

Adaptation theory

Describes adjustment of living matter to other living things and the environment.

Developmental theory

Describes orderly and predictable growth and development from conception to death.

What four concepts are common in nursing theories?

Person, environment, health, and nursing.

What were major contributions of Florence Nightingale?

She distinguished nursing from medicine, established nursing education and hospital standards, emphasized nutrition and continuing education, addressed health and illness, and used accurate records that contributed to nursing research.

Clara Barton

Civil War nurse who organized hospitals/nurses and established the American Red Cross in the United States in 1882.

Dorothea Dix

Civil War superintendent of Female Nurses of the Army and advocate for reform in treatment of people with mental illness.

Mildred Montag

Established associate degree nursing education in 1958.

Lillian Wald

Founder of public health nursing; established a neighborhood nursing service for the sick poor on New York City's Lower East Side.

What are the entry-level roles of the associate degree nurse listed in the presentation?

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

What are aims of care coordination?

Link patients with community resources, improve information exchange, and reduce fragmentation and duplication of services.

Nurse navigator

A clinically trained nurse who identifies/removes barriers to treatment and serves as a central point of contact for patient care.

Patient navigator

A nurse, social worker, or lay person who focuses on support aspects of care.

What are essential components of discharge planning?

Assess patient/family strengths and limitations and the environment; implement and coordinate care; consider resources; and evaluate effectiveness.

What should happen when a patient leaves AMA?

The patient is legally free to leave, should be informed of risks, signs a witnessed release form, and the form becomes part of the medical record.

What are the six components of the infection cycle?

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

Infectious agent

A disease-producing microorganism; examples include bacteria, viruses, and fungi.

Reservoir

The natural habitat where an organism lives and grows.

Means of transmission

The method by which an organism moves from one source/host to another.

Portal of entry

The route through which an organism enters a new host.

Bacteria

The most significant and prevalent infectious agents in hospital settings according to the course presentation.

Virus

The smallest type of microorganism listed in the infection presentation.

Parasites

Organisms that live on or in a host and rely on the host for nourishment.

What factors affect an organism's potential to produce disease?

Number of organisms, virulence, competence of the person's immune system, and length/intimacy of contact.

What are possible reservoirs for microorganisms?

Other people, animals, soil, food, water, milk, and inanimate objects.

What are means of transmission?

Direct contact, indirect contact, vector, fomite, droplet, and airborne transmission.

When is hand hygiene required during patient care?

Before and after patient contact, before gloves/invasive procedures, after body-fluid or contaminated-site contact, after touching nearby objects, and after glove removal.

When should soap and water be used for hand hygiene?

When hands are visibly dirty/soiled, after contact with blood/body fluids, before eating, after restroom use, and when certain organisms such as C. difficile or anthrax are known or suspected.

How long should hands be rubbed when washing with soap and water?

At least 20 seconds.

When are alcohol-based hand rubs recommended?

When hands are not visibly soiled.

Transient flora

Microorganisms loosely attached to the skin that are removed relatively easily.

Resident flora

Microorganisms found in skin creases and more difficult to remove.

What body substances are covered by Standard Precautions?

Blood; body fluids, secretions and excretions except sweat; nonintact skin; and mucous membranes.

Transmission-Based Precautions

Precautions used in addition to Standard Precautions for suspected or known pathogens spread by contact, droplet, or airborne routes.

Contact precautions

Used for organisms spread by direct or indirect contact; use appropriate PPE, limit transport, and avoid sharing patient-care equipment.

Droplet precautions

Used for infections spread through droplets; private room when possible, PPE on entry, limit transport, and place a surgical mask on the patient during necessary transport.

What infections are listed as examples requiring droplet precautions?

Influenza, rubella, mumps, diphtheria, and adenovirus in children.

Airborne precautions

Use a private negative-pressure room with the door closed and respiratory protection; limit transport and mask the patient during necessary transport.

What are key rules for using PPE effectively?

Put PPE on before patient contact, choose PPE for the exposure, work clean to dirty with gloves, minimize surface contact, avoid touching/adjusting PPE, keep gloved hands away from the face, and replace torn/heavily soiled gloves.

What are examples of health care-associated infections listed in the slides?

CAUTI, surgical-site infection, CLABSI, MRSA infections, and C. difficile infections.

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 health.

What human dimensions affect health and wellness?

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

Risk factor

A factor that increases the chance of illness or injury; risk factors may be modifiable or nonmodifiable.

What is holistic health?

Care that considers the whole person.

High-Level Wellness Model

A model emphasizing good physical, mental, and emotional health and functioning at one's maximum potential; a person may be well regardless of health state.

Health Belief Model

A model focused on what people perceive or believe to be true about their health, including susceptibility, seriousness, and benefits of 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.

Primary prevention

Activities that promote health and prevent disease or injury before it develops, such as vaccination, family planning, helmets, car seats, and healthy diets.

Secondary prevention

Screening for early detection of disease followed by prompt diagnosis and treatment; examples include routine exams, colonoscopy, mammography, and oral exams.

Tertiary prevention

Treatment aimed at reducing disability, preventing complications, and rehabilitating the patient to the maximum level of functioning.

Health disparity

A health difference closely linked with social, economic, and/or environmental disadvantage.

Disease

Pathologic changes in the structure or function of the body or mind.

Illness

A person's response to disease in which functioning changes compared with the previous level.

Acute illness

Rapid onset, relatively short duration (less than 3 months in the presentation), and possible cure/return to normal function.

Chronic illness

Usually slow onset with permanent/irreversible changes, long-term or lifelong care, and possible periods of remission and exacerbation.

What are the four stages of illness behavior?

Experiencing symptoms; assuming the sick role; assuming a dependent role; achieving recovery and rehabilitation.

Culture

A framework of shared beliefs, values, and behavioral expectations that is integral to health and illness.

Cultural diversity

Coexistence of differences within a group/population.

Cultural respect

Respecting people regardless of values or beliefs and recognizing one's own biases while providing diverse care.

What can inhibit culturally competent care?

Stereotyping, implicit bias, culture conflict, culture shock, assimilation, cultural imposition, and cultural blindness.

What behaviors characterize culturally competent nursing care?

Self-awareness; understanding the patient's culture; accepting/respecting differences; recognizing differing beliefs/values; resisting judgment; being open to cultural encounters; and accepting responsibility for cultural competence.

What should a cultural assessment include?

Beliefs, values, traditions, health practices, culturally defined needs, beliefs about causes/healing/pain, attitudes toward seeking care, and practices that can be incorporated into care.

Who should be used for language interpretation in health care?

A health-care competent interpreter rather than a family member.

What is the nurse's role in diagnostic studies?

Provide care before/during/after tests, witness consent when appropriate, schedule tests, reinforce teaching, and collect relevant health/family/functional histories.

What are key steps for collecting a blood specimen?

Use at least two patient identifiers—not room number—perform hand hygiene, don gloves, collect by venipuncture, document collection, and perform hand hygiene afterward.

What aftercare is needed after venipuncture?

Apply direct pressure until bleeding stops and monitor for hematoma, bleeding, infection, or lightheadedness.

CBC

Complete blood count; measures RBCs, WBCs, platelets, hemoglobin, and hematocrit and can help identify anemia, infection, bleeding/blood disorders, establish a baseline, and monitor treatment.

Urine culture and sensitivity

Performed when indicated to identify bacteria and determine which antibiotics the organism is sensitive to.

What should a patient do before collecting a clean-catch urine specimen?

Clean the area before voiding.

COCA for normal urine findings

Color, Odor, Clarity, Amount.

What does a fecal occult blood test assess for?

Gastrointestinal bleeding.

What is the purpose of a stool culture?

To identify a pathogen.

What is a sputum culture/examination used for?

To identify causes of pulmonary infection and help diagnose respiratory diseases such as bronchitis, TB, lung abscess, and pneumonia.

How should sputum ideally be collected?

In the morning before breakfast if possible; collect about a teaspoon in a tight-fitting container and send it to the lab promptly.

X-ray

Imaging using a small amount of radiation; may identify fractures, collapsed lung, heart disease, cancer, infection, or medical-device placement.

What preparation may be needed for an X-ray?

Remove clothing/jewelry from the area; contrast or NPO status may be needed depending on the study; chest X-ray may require a deep breath and breath hold.

Ultrasound

Uses sound waves and a transducer against the skin to visualize internal organs/structures without radiation.

What should the patient know about ultrasound?

It is painless and does not use radiation; gel is applied; food/fluid restriction may sometimes be required; normal intake can usually resume afterward unless contraindicated.