Comprehensive Study Notes on Nursing Concepts

Nursing Informatics

• Nursing informatics is the integration of technology and physical devices with nursing knowledge and clinical decision-making skills.
• In 1992, the American Nurses Association designated nursing informatics as its own nursing specialty.
• Barcode scanning has greatly assisted in improving client safety and accurate documentation in EHRs.

Health Literacy

• Healthy People 2020 considers health literacy a subheading to the social determinants of health and healthcare.
• Low health literacy may lead to patients being non-compliant or unable to learn about their diseases.

Simulation Labs

• Simulation labs provide a practice environment, but they are not the same as real-life experience with patients.
• Skills learned in simulation labs need to be adapted to real patient scenarios, as anatomical variations exist.

Informatics and Medication Errors

• Informatics involves using EMRs to prevent medication errors.
• However, people can bypass safety measures, so informatics doesn't completely eliminate errors.

Evidence-Based Practice

• Evidence-based practice is based on research and studies that have been conducted.
• Examples in wound care:
  • High protein intake (if not renal patient).
  • Turning and repositioning.
  • Hygiene care.
  • Vitamin C.
• High protein helps feed the wounded area.
• Wound care should be done as directed, leaving the wound saturated.
• For diabetic patients, blood sugars need to be controlled as high blood sugars hinder wound healing.

Patient Education

• Teach patients about:
  • High protein intake (if not renal patients).
  • Turning and repositioning.
  • Vitamin C.
  • Products like Prostat to help with wound healing.
• Cranberry juice (pure) can help prevent UTIs, or cranberry tablets can be taken instead.
• Nurses are educators, teaching patients to care for themselves.

Benefits of Evidence-Based Practice

• Improves client outcomes.
• Enhances nurses' experience and professional satisfaction.
• Lowers the cost of quality healthcare.
• Provides a framework for clinical judgment based on research and quality improvements.

Hospital Projects

• Hospitals undertake projects to be certified in JACo and become Magnet hospitals.
• Units choose a project (e.g., pain, falls) to improve patient safety.
• Data collection is used to identify patterns and address issues like high re-hospitalization rates.

Spirit of Inquiry

• The spirit of inquiry is the desire to clarify complex issues through research.
• It aims to improve client outcomes by keeping patients safe and happy at home.
• It encourages nurses to explore their approaches to problem-solving and reflect on their performance.

Scientific Literature

• Use peer-reviewed, published scientific research articles, not just Google or social media.
• Acceptable sources:
  • ANA (American Nurses Association).
  • NLM (National Library of Medicine).
• Consider the source of evidence; scientific processes should inform evidence-based practice.

Scientific Method

• The scientific method is a systematic research process applied to nursing practice.
• Medications are tested, often on animals, before being released to the public.
• Empirical data is collected through observation, assessment, and measurements to minimize bias.

Nursing Process

• The nursing process (assessment, analysis, planning, implementation, and evaluation) is a tool for evidence-based practice and improves client outcomes.

Clinical Guidelines

• Clinical guidelines are methodical statements focusing on specific plans of care for specific client populations.
• They are stored in the National Guideline Clearinghouse and aim to optimize client outcomes and improve cost-effectiveness.
• Research to improve client outcomes can bring down costs in the long run.

End-of-Life Care: Hospice

• Hospice care provides medical care to support clients with terminal illnesses so they can live their last days as best as possible.
• It controls the illness but does not cure the patient.
• Antibiotics can be given for infections; IVs, oxygen, and pain medicine can be administered for comfort.
• Chemotherapy is generally not given, though rare exceptions may occur.
• Care can be provided at home or in a facility.
• Originally offered only to clients of the patient's brain, Huntington's and MS patients can go on hospice.
• Kidney disease patients can decline dialysis and opt for hospice.

Interprofessional Team

• A holistic care team should treat the whole person, including caregivers and family members.
• Hospice care supports family members through the grieving process.
• Spiritual leaders can be called in.
• Family members may experience denial, anger, or bargaining.

Hospice Admission Criteria

• Admission requires a healthcare provider's diagnosis of life expectancy of less than six months.
• Some patients may live longer than six months or come off hospice and then return.
• Morphine helps ease pain and relax the patient, but it does not kill them.

End-of-Life Care: Palliative Care

• Palliative care is holistic care through the lifespan for clients with severe medical illnesses, particularly those near the end of life.
• The goal is to improve the quality of life for both the client and family caregivers.
• It focuses on lessening the client’s suffering.
• It is implemented earlier in life-threatening situations.
• Palliative care can be given while the patient is still engaging in curative treatments.
• Hospice takes away most meds and deals with symptoms.
  Patients may salivate extra, and drying out the salivation so that they're not choking and aspirating
  Palliative care: Dealing with symptoms and pain.

Physiological Changes at End of Life

• The terminal phase of life is characterized as actively dying or imminent death.
• Breathing and respirations:
  • Shortness of breath.
  • Retention of secretions (death rattle).
  • Periods of apnea.
  • Cheyne-Stokes respirations (irregular rate with quick breaths and periods of apnea).
• Pain:
  • Experienced by nearly 60% of adult hospice clients with cancer.
• Temperatures:
  • The ability to regulate body temperature diminishes.
  • Patients may experience both increased and decreased temperatures.
• Mottling:
  • Occurs hours or days before death.
  • Upper and lower extremities become cool to the touch.
  • Skin may appear bluish or pinkish/grayish in tone due to decreased blood perfusion. Caused by inability to pump blood effectively.
• Vision and Hearing:
  • Clients may experience hallucinations or report seeing and hearing those who have already died.
    People start reaching, and the client may be actually reaching for them like they are actually there.

Dignity in End-of-Life Care

• Dignity is an everyday necessity essential to well-being.
• Most complaints at the end of life are associated with a lack of caring.
• Illness leads to a loss of control, lessening the sense of dignity.
• Nurses should provide privacy, cover the patient when exposing them, and address the patient by name.
• Even if the patient does not appear to be responsive, nurses should explain what they are doing.
• Hearing is the last sense to go.
• Treat patients with name and give them dignity.

Good Death and Postmortem Care

• Healthcare providers, families, and caregivers are responsible for providing a good death.
• This includes pain management, planning for death, and providing closure.
• For postmortem care, nurses should be aware that the patient may sit up in bed or have bodily fluids come out.
• Wear protective coverings during postmortem care.
• Two people should perform postmortem care.
• Tag the patient's toe with MR number, date of birth, and name.

Regulations and Scope of Practice

• Before calling the morgue, ensure the patient is dead by observation.
• Someone must provide certification.
• LPNs have boundaries on pronouncing death.
• RNs can pronounce death, in nursing home, depending on regulations.
• Nurses must know their scope of practice and agency's regulations.
• Make sure that you know that your patient is an organ donor or not an organ donor. Rushing them and keep that heart beating if they're not wasting time.
• If you ever notice the honor where everybody stands in the hallway. The machine is keeping them alive for goodbyes. They are done. You can do any exam possible. If not, they get a vegetable.
• Understand that you cannot prescribe medicine.

Cultural Considerations

• Hindu diet: steamed vegetables, vegetarian.
• Muslim faith: no pork.
• Orthodox Jew: kosher (no mixing meat and milk).
• If a patient doesn't speak the same language: use translation, pictures.
• Postmortem care for a Muslim client: only provide care or family and ensure they are Muslim.
• Asian American culture: avoid direct eye contact.
• Chinese culture: address by the last name unless told otherwise.
• Patients may be at ease of communication.

Data Collection and Computer Access

• Only provide computer access to those who have access (don't provide it to anyone else).
• EMR's mitigate erros

Defining Words

• Akathisia: movement disorder.
• Anhedonia: inability to experience pleasure.
• Anergia: lack of energy.
• Denial- People refuse to believe you when they are bad/death. Example: people refuse the terminal cancer
  Stages of breathing-dabda: these stages will show our patience breathing, also help with pain and keep in comfortable.

Pain and Emotion Care

• First, care for them pain.
  lways try to make our patient comfortable and happy in bad times.

NCLEX Question Tips

• A new question, priority question

Analgesic

Provide medication and look for the medication to pain.

HIV

Remember to protect yourself with this patient.

Organ Donation

The nurse may serve as a witness to a consent for organ donation.

Palliative Care and Therapeutic Responses

Palliative care helps retrieve the symptoms the patient is having, does not cure the patient. Therapeutic Response- shoulders drop, facial muscle relax, pulse within range.

Grief Anticipation

Anticipatory Grief, new diagnosis metastatic liver cancer. If you hear the the is spreading, than go ahead and pick the patient and make sure they good!

Postmortem Care

• After someone passes, please get a, death certificate, organ donor status. Then the order is, remove the equipment, clean the body, label the body.

Body Temperature

• Body temperatures is how you stay safe so your patient does get hot or code.

Adults, circle around is safe. Tympanic Circle until the ear fit snug. Children out and down, adults, and up.

Lumbar Puncture

• encourage the food. Then monitor for hematomas. And reduce the risk for patients to not get headache, always keep the patients flat. and do not let get up ever one hour at least. You can touch them the best you can.
  Remember the safety tips.

Vancomycin

• Before the vancomycin: You should administer the medicine as soon as Possible.
  Patient timing is important because 15 and thirty, you want that safe nurse to control the medicine
  Trough is always 15 minutes before or after the medicine

Stomach Issues

Never trust or crush a tablet if they are having swallowing troubles. You will need to ask the Doctors for changing that prescription
Never give the potation directly never ever. You have to make sure the IV always slow.

Medication Education

Remember never give some people medicine. Always encourage

Hot water Anema

Always lower the water bag of Anemal. If you the patient start cramping. Patients will tell you. Please keep it at good temperature as well.

Intradermal and TB Injections

You must give that to the skin or orange inject and remember what you reading the lab books. Look for the bobble. clean the skin also taut the skin as well as you can
Always teach the pinch and do not inject yourself and learn all you techniques

Common Cold

Ecechasie- is given the prevent the common for
another medicine need to be discussed what and need or provider

• Remember all the tips to see if the patients are not breathing good or has another sign or symptoms

Safety and Emergency

A patient is cholking and how do you help the patient.

• Are you Ok! Are you Ok? and do the best you can never wait
• Do abdominal thrust Heimlich. To do is get behind the client

Mental Health Patients

• Keep watching your patients. Mental health facility is experiencing delusions there. They have to change the topic so you need to ask what they doing and what they eat
  Long time patient a facility who has trouble and they cannot tell. They just feel weird somethings. Make they comfy or check again, or check some more because they will say there is.

Other Nursing Considerations

• Nursing Consideration- 5th intercostal, apical pulse. Fifth intercostal.
• The RN is solving the issue what I can before calling the doctor or not. So always have that in your mind!
• And never let anyone stop you from helping! You are more than what you see!
• New depression or anorexia, have the client some calories. It works what finger food, so you have it small high calorie
• Unopen item the patient that had pareoned , the one there that they were going poison them

Client refusal

Educate them with the safety tips
Music for comfort, they can distract them and provide movement limitations

• So always pick the comfort pain is out for music!!!

Do not let the force stay up, keep them pain to and position!

• You are the best!