Recording-2025-05-21 Nursing Process

Nursing Informatics

• Integration of technology and physical devices with nursing knowledge and clinical decision-making skills.
• American Nurses Association designated it as a specialty in 1992.
• Barcode scanning improves client safety and accurate documentation in EHRs.

Health Literacy

• Defined by Healthy People 2020 as a subheading to social determinants of health and healthcare.
• Lack of health literacy can lead to patients' non-compliance and inability to learn about their diseases.

Simulation Labs

• Integration of simulation is not the same as working on a live person.
• Experience in simulation labs is different from real-life clinical practice.

Preventing Medication Errors

• Use EMRs to prevent med errors, but there is always a bypass.

Evidence-Based Practice

• Everything done in nursing is based on evidence and prior studies.
• For wound care, advise high protein intake (if not a renal patient), turning, repositioning, hygiene care, and vitamin C, which have been shown to aid wound healing.
• High protein helps feed the wound area.
• Keep wound saturated, as directed, noting that every wound is different, to prevent complications.
• Control blood sugars in diabetic patients to promote wound healing since high blood sugars inhibit it.
• Teach patients about high protein intake, turning, repositioning, and vitamin C.
• Advise women prone to UTIs to drink pure cranberry juice daily or take cranberry tablets, which have evidence of preventing UTIs.
• Nurses are educators and teachers, educating patients and families so they can care for themselves.
• Improves client outcomes, nurses' experience, and professional satisfaction, lowers healthcare costs, and provides a framework for clinical judgment based on research and quality improvements.
• Hospitals undertake evidence-based practice projects to get certified by organizations like JACo and achieve Magnet status.
• Units conduct projects on pain, falls, etc., to improve patient safety.
• Monitor hospitalization rates to pinpoint and address patterns, even narrowing by clinicians or doctors, to reduce readmissions.

Spirit of Inquiry

• The desire to clarify complex issues through research and trends that influence client outcomes.
• Aims to prevent hospitalizations, improve client outcomes, and foster awareness and problem-solving.

Scientific Literature

• Use peer-reviewed, published scientific research articles.
• Avoid using blogs or social media, as not everything posted is real or accurate.
• Use articles from reputable sources like the ANA or NLM.

Considering the Source

• Nurses must consider the source of their evidence, using scientific processes to inform evidence-based practice.

Scientific Method

• A systemic research process where knowledge is applied to nursing practice outcomes and reevaluated.
• Medications are tested on animals before being given to humans.
• The speaker references the COVID vaccine being pushed out without following the FDA process where the influenza vaccine took years to be given out.
• Empirical data is collected through observation, assessment, and measurements to minimize bias and discover new knowledge applicable to large groups of clients.

Nursing Process

• A tool for evidence-based practice: assessment, analysis, planning, implementation, and evaluation.
• These improve client outcomes.

Clinical Guidelines

• Methodical statements that focus on specific plans of care for specific client populations.
• Stored in the National Guideline Clearinghouse and used to optimize client outcomes and improve cost-effectiveness.

End of Life/Hospice Care

• Administration of medical care to support the client who has a terminal illness so they can live the last days of their life as best as they can.
• Provides treatment that will not cure the patient but control the illness.
• Palliative care controls pain, offering pain management while still receiving regular home care.
• Hospice is end of life care where the goal is no longer to cure the patient.
• Antibiotics, IVs, and oxygen can be given in hospice care to treat infections or manage symptoms, but chemo is typically not given.
• Pain medicine is typical for hospice, focused on comfort whether at home or in a facility.
• Originally offered only to clients of the patient's brain is there, but they're Huntington's, they go on hospice. Patients with Huntington's, MS, or end-stage renal disease who stop dialysis can opt for hospice.
• Hospice care should support the families through the grieving process.
• Admission criteria include a healthcare provider's diagnosis of a life expectancy of less than six months.
• Morphine decreases respirations but is used to ease pain and relax the patient.
• Hospice provides a support box with medications and instructions for family members, with hospice nurses available for guidance.
• Palliative care is holistic care provided through the lifespan for severe medical illnesses, especially nearing end-of-life to improve quality of life.
• Early intervention helps patients learn to manage their conditions and symptoms before hospice.
• Palliative care addresses pain and symptoms while the clients are still engaging in curative treatments, like chemo or dialysis.
• Hospice typically removes most meds and focuses on medicines for symptom management.
• Hospice addresses the families as well.
• Nurses learn to cope with death and grief, although initial experiences can be traumatizing.

Physiological Changes at End of Life

• Terminal phase is characterized as actively dying or imminent death.
• Breathing patterns change, including shortness of breath, retention of secretions (death rattle), Cheyne-Stokes respirations, and periods of apnea.
• Pain affects nearly \60\% of adult hospice clients who have cancer.
• The nervous system's ability to regulate body temperature diminishes, causing increased or decreased temperatures.
• Mottling occurs hours or days before death with coolness and discoloration in extremities where circulation diminishes.
• Clients may experience hallucinations or report seeing/hearing deceased individuals.

Dignity

• Essential to patient well-being; lack of caring is a major complaint.
• Maintain client privacy and respect, addressing their name, and explaining care even if unresponsive.

A Good Death

• Includes pain management, planning, and closure with spiritual support.

Postmortem Care

• Physical care performed after death by an aide with an RN.
• Tag the to with a MR number, date of birth, and name.
• Be aware of potential bodily fluids.
• The patient may sit up in the bed and there may be leakage coming out of urine and feces.
• The LPN cannot pronounce a time of death or state the patient is dead.
• In home-care the RN cannot pronounce a time of death either.
• RN card vs LPN card: when studying you will want to get an LPN over an RN card, this is because you practice under the LPN scope, or things can get confusing.
• Ensure the patient's organ donor status is known to preserve that option.
• Honoring an organ donor means a rush for surgery as the heart is kept beating.
• Funeral services and postmortem care are graphic with descriptions of processes involved, including dealing with bodily fluids and procedures.

Other considerations in healthcare

• Avoid the question if they're Asian or Hindu, you would need to ask the family member.
• Ginger is good for digestive issues and nausea.
• The Hindu diet consists of steamed vegetables.
• Muslims don't eat pork.
• Orthodox Jews eat Kosher foods.
• Ensure adequate pictures are used in teaching for those who speak different languages to mitigate miscommunication.
• Always consider language barriers when teaching, seek proper translate for a more clear understanding.
• Touch Muslim clients for postmortem care as a non-muslim and same sex caregiver is highly favored.

Nursing Actions

• Understand the client and cultural background when entering the medical practice.
• Avoid eye contact, respect and avoid the client personal space, and avoid physical contact for Asian American Patients.

Clinical Information

• Speak to the client by their last name to establish a more personable rapport.

When sharing computer access what are you looking to mitigate?

• By having EMRs, everyone from multiple departments are mitigating the same things and language for better collaboration.

Definitions

• Akathisia and movement disorders.
• Anhedonia means an inability to enjoy pleasurable things.
• Anergia means the feeling of weariness.

Grief

• A client who is newly diagnosed with cancer may be in denial.
• These are one of the many stages associated with grief.
• The Acronym Dabda helps show the 5 stages of grief and grieving process.

Priority action by the nurse should be included in a patient's care plan.

• A patient who should be included is that of a terminal client.
  Determining hospice, palliative, and patients should always be at 100 pain and emotion free.

Priority needs for the nurse should always be Maslow scale

• When a patient goes through Maslow scale, look for the pain for their pain. Pain would be the highest priority.
• HIV-positive client should have meds readily available when speaking in reference to prioritizing medications.

Analgesic

• An HIV-positive for more than 10 years is at end of life, and at this point analgesics should be in their meds.

• Each patient should enter with a medical plan as if they are HIV patients. And take the precautions from this in order to prevent the transfer.

Organ Donation

• Serving as a witness would aid, by providing consent with the doctor.
  When thinking about this, consider one to live through someone else, keep in their honor and ask you to be honored.
  Can I as a nurse, ask a patient as if a organ donation is a good idea, the answer is no.

Medical Waste

• When thinking about medical waste, think to yourself that organs will be disposed of, not kept or recycled by the doctor.

Palliative Care

• Palliative care should improve symptoms and quality of life.
  When should the patient have palliative treatment?: A client with a new diagnose should have anticipatory grief in the setting.
  Newly diagnosed patients with metastatic liver cancer is likely to recover and should have palliative care.

Postmortem

• The steps include:

1. Ensuring the patient is dead.
2. Check organ status and inform if applicable.
3. Remove medical Equipment.
4. Clean the patients.
5. Id the body.

Temperature Techniques

• With tympanic, the ear should include a circular manner.
• Lumbar Puncture should:

1. Have lots of fluids/Encourage fluids.
2. Monitor hematoma.
3. Have small risks for fluid intake to reduce the risk of headache.
4. For at least a hour, stay flat. Time and do not allow the patient to move.

Vancomycin

• Medication is administered IV, and needs to be taken within 20 mins of procedure, before and after.
• 15 minutes before, 30 minutes after.

Medical Information

• Trough is 15 min before time.
• PEAK is 30 min after time.
• This medication with this method needs to happen everywhere or the patient can die.
• Enteric: The Tablet should never be crushed.
  When looking at it for treatment look for a pharmacy to prescribe something completely similar.
  Don’t IV potassium, IV slowly. This in order to treat cardiac.

Hot Enema

• Lower the bag to easy ease.
• Inredurmal you will need what?

1. Taut skin.
2. Clean the site and use. Non dominate
3. Tb needs to have that layer.

Herbal Medication Information

• Herbal medications prevent contraindictions.

1. Always consult with the provider. This to ensure the client is treated with respect.

• Choking: is always grasping at the side.