Study Notes on Patient Care Management

Chapter 21: Managing Patient Care

Transformative Leadership
  - Focuses on change and innovation through team development.
  - Serves as a mentor for staff and fosters moral agency in nursing.
  - Shares ideas, empowers staff, appreciates contributions.
Servant Leadership
  - Prioritizes serving others before seeking leadership roles.
  - Focuses on the needs and personal growth of staff members.
  - Embodies humility and calmness.
Nursing Care Delivery Models:
  - Aims to achieve desirable patient outcomes.
  - Common components including nurse-patient relationships, clinical decision-making, patient assignments, interprofessional collaboration, and environmental management.
  - Types:
    1. Team Nursing:
      - Care by a group led by an RN.
    2. Primary Nursing:
      - One RN takes responsibility for a patient's care from admission to discharge.
    3. Total Patient Care:
      - An RN is responsible for all care aspects for one or more patients; mainly found in critical care areas.
    4. Case Management:
      - Coordinates healthcare services across care levels while managing costs and quality.
      - Focused on patient outcomes and resource utilization.
      - Case managers are often Advanced Practice Registered Nurses (APRNs).
Shared Governance:
  - Decentralized structure in healthcare agencies.
  - Promotes staff involvement in decision-making that shapes agency identity and success.
  - Encourages managers to decentralize decision-making.
Key Concepts:
  1. Autonomy: Freedom of choice and responsibility.
  2. Authority: Legal ability to perform tasks and make decisions.
  3. Accountability: Responsibility for actions and patient care outcomes.
Delegation:
  - Assigning responsibility to another qualified person in specific situations.
  - Use the 5 Rights of Delegation:
    1. Right Task: Tasks must be within the delegatee's scope of practice.
    2. Right Circumstance: Evaluate the patient’s status before delegating.
    3. Right Person: Ensure delegatee has necessary skills.
    4. Right Directions and Communication: Provide clear task descriptions.
    5. Right Supervision and Evaluation: Monitor and evaluate task completion.
SBAR (Situation, Background, Assessment, Recommendation): A structured communication tool for relaying important patient information effectively.
Case Study Example:
- Administered oxycodone and ibuprofen for post-surgical pain; used SBAR to communicate with a healthcare provider when pain was rated as 8/10.

Chapter 38: Activity and Exercise

Benefits of Physical Activity:
  - Elevates mood and attitude.
  - Enhances physical fitness, assists in quitting smoking, boosts energy levels, and manages stress.
  - Improves sleep quality and self-image.
Body Mechanics:
  - Coordination of musculoskeletal and nervous systems for movement.
  - Body Alignment: Proper alignment minimizes strain, enhances comfort, maintains muscle tone, and conserves energy.
  - Gravity & Friction: Balance is critical to prevent falls; friction opposes movement.
Deconditioning:
- Loss of muscle mass and strength due to inactivity.
Activity Tolerance:
- Refers to the amount of exercise one can perform without undue fatigue.
Factors Influencing Activity Intolerance:
- Includes skeletal, muscular, and metabolic illnesses; hypoxemia; decreased cardiac function; pain; and sleep disturbances.
Types of Exercises:
  1. Isotonic: Muscle contraction with movement, e.g., walking.
  2. Isometric: Muscle tension without movement, e.g., planks.
  3. Resistive Isometric: Contracting the muscle while pushing against a stationary object, e.g., push-ups.

Chapter 39: Immobility

Mobility: Ability to move freely; immobility refers to inability to do so.
Systemic Effects of Immobility:
- Impacts metabolic, respiratory, cardiovascular systems, etc.
- Ex. Hypostatic pneumonia, DVT, pressure injuries (skin breakdown).
Postural Disorders:
  - Lordosis: Excessive lumbar curvature.
  - Kyphosis: Increased thoracic convexity.
  - Scoliosis: Lateral curvature of the spine.
Principles of Patient Transfer and Positioning:
- Use mechanical lifts, ensure a wide base of support, and position correctly to reduce injury risk.

Chapter 43: Sleep

Sleep: A cyclical physiological process.
Circadian Rhythm: Biological internal clock regulating body functions.
Sleep Phases:
  1. NREM Sleep: 75% of sleep, contains 3 stages.
     - N1: Light sleep; easily aroused.
     - N2: Sound sleep; relaxation.
     - N3: Deep Sleep; difficult to wake
  2. REM Sleep: 25% of sleep; vivid dreaming, muscle atony occurs.
Functions of Sleep: Restores biological functions, consolidation of memories, and emotional transference.
Factors Interfering with Sleep:
- Physical illness, stress, diet, medications.

Chapter 49: Visual, Auditory, & Sensory Alterations

Senses:
- Visual, auditory, tactile, olfactory, gustatory sensory components.
Sensory Overload: An individual becomes perceptually overloaded and cannot selectively ignore stimuli.
Visual Deficits: Conditions like presbyopia, cataract, glaucoma, macular degeneration.
Hearing Deficits: Age-related changes, cerumen buildup, and exposure to ototoxic medications can contribute.

Chapter 45: Nutrition

Nutrition: Essential for bodily function, growth, and development.
- Food Security: Access to sufficient nutrition.
- Medical Nutrition Therapy (MNT): Assists in managing conditions through diet.
Basal Metabolic Rate (BMR): Energy expended at rest; varies across individuals.
Dietary Guidelines: Aimed to promote health and lessen chronic diseases; includes understanding nutrient density.
Carbohydrates: Primary energy source; classified into monosaccharides, disaccharides, and polysaccharides.
Proteins: Critical for the body's repair and growth; sourced from meat, fish, legumes.
Fats: Most calorically dense nutrient; categorized into saturated, unsaturated, and essential fatty acids.