Nursing Code of Conduct
� Participating in intra-professional collaboration
� Avoiding conflicts of interests
� Maintaining respect for human dignity
� Integrating professional values with personal values
The Code of Ethics from the American Nurses Association (ANA) states in
po
Nursing Ethics
Ethics: moral principles that govern behavior; ideal, standards
Principles:
� Autonomy: duty to allow patient to make independent decisions
� Veracity: duty to tell the truth
� Fidelity: duty to keep promises and commitments
� Justice: duty to provide equ
Ethical Dilemmas
Issues surrounding quality-of-life, end-of life, and DNR orders most often
trigger ethical dilemmas, when no clear course of action is apparent.
Obtain a referral to ethics committee for disagreements about treatments:
� Between family members
� Among hea
Advocacy
What it is: action or series of actions that argues for, speaks in favor of,
recommends, or supports another person, place, or thing
Nursing Advocacy:
� Integrates individuality, professionalism, and empowering
� Involves a process of analyzing, counselin
Kubler-Ross Stages of Grief
Patients, families, and other caregivers can progress through these stages.
� Denial: avoiding the inevitable
� Anger: expressing emotions previously bottled-up
� Bargaining: trying to find a way out
� Depression: acknowledging the inevitable
� Acceptance
Leadership Styles
Autocratic: unilateral, dictatorial, works toward single goal; meets resistance
from mature, experienced staff
Democratic/participative: team approach, staff participation, retains responsibility for outcome
Laissez-faire: little control; leaves decision
Shared Governance
What it is:
� A model of nursing practice designed to improve work environment, satisfaction, and nurse retention
� Champions staff as most important asset of organization
� Encourages autonomy, empowerment, involvement, and participation
� Teams and grou
Adult Learning
The education process should reflect the nursing process (assess, plan, implement, evaluate)
� Multiple sensory avenues for learning increases learning and retention.
� Doing and saying (teach-back) is more effective than reading and hearing.
� Learning n
Learning Barriers
Physical Impairments: inadequacies of the five senses; impaired mobility
� Cognitive: mental disability or impairment; dyslexia, phobias
� Language: aphasic; lack of fluency, reads at less than 8th grade level
� Emotional: fear/superstitions, anxiety, dep
Teaching Strategies�Adults
Assess: mental and physical capabilities, perception of the problem, preferred
learning style
Plan: establish mutual goals with patient that are specific, practical, attainable, relevant, and culturally sensitive
Intervene: use multiple methods to enhance
Maslow's Hierarchy of Needs
Physiological: basic needs such as air, water, food, shelter, and freedom from pain (comfort)
Safety: free from harm or threat of harm; stability
Love/Belonging: friendship, acceptance, affection; support system
Esteem: self-respect, self-confidence, rewa
Nursing Diagnoses, Domains
NANDA-II taxonomy, 13 Domains (47 Classes, 216 Diagnoses)
� Activity/Rest
� Comfort
� Coping/Stress Tolerance
� Elimination
� Growth/Development
� Health Promotion
� Life Principles
� Nutrition
� Perception/Cognition
� Role Relationships
� Safety/Protecti
Nursing Diagnoses, Format
Diagnosis: (example) Imbalanced nutrition: Less than body requirements
Related to: (example) Insufficient caloric intake
Evidenced by: (example) Weight loss
Expected Outcomes: (example) The patient will achieve and maintain adequate weight (use NOC termin
Nursing Intervention Classification
What it is:
A list of 554 interventions (in 2013 6th ed.) that nurses perform; includes direct, indirect, collaborative, and independent interventions that address both physiologic and psychosocial aspects of patient care. Interventions fall into three ca
Nursing Outcomes Classification
What it is:
A system which describes patient outcomes sensitive to nursing intervention; includes 490 outcomes in the 5th edition (2013); a means of standardizing nursing language used in the nursing process, similar to NANDA for
diagnoses, and NIC for nu
Problem Prioritization
What it is:
A means of focusing nursing interventions on the most important patient problems; usually follows Maslow's Hierarchy and the ABCDE mnemonic.
Nursing Application:
Once immediate ABC needs are met, the patient and family should participate
in fo
Collaboration
What it is:
A dynamic process that produces a synthesis of perspectives and shared responsibilities to address a problem set that cannot be handled by a single individual
Nursing Application:
The team approach is essential to patient care. Collaboration a
Core Measures
Standards of care that improve patient care and outcomes
� Data is submitted to CMS (Medicaid/ Medicare) and TJC
� Includes reports on diseases/conditions seen, hospital-acquired conditions, Emergency Department (ED) care, and the Surgical Care Improvemen
Core Measures: Reportable HospitalAcquired Conditions
Foreign object retained after surgery
� Air embolism
� Blood incompatibility
� Stage 3 and 4 pressure ulcers
� Falls and other traumas
� CAUTIs (urinary catheter infections)
� Vascular catheter-associated infections
� Manifestations of poor glycemic contr
Core Measures: Prevention
Core Measures also address prevention. Sets of data collected are listed.
� Immunization (IMM): pneumococcal immunization rates for overall, age 65+, and high-risk groups ages 5-65; influenza immunization rates
� Tobacco Cessation (TOB): screening, treatm
Health History Components
Biographical info (demographics): patient registration form, psychosocial data
� Chief complaint (CC): reason for visit; patient's exact words; include how long complaint has been going on (i.e., "belly's been hurting for two days")
� Health History (HPI,
HPI Details
Under HPI (history of present illness), include the following:
Onset�"when"
Duration�"how long"
Location�"where"
Quality�"what type"
Quantity�"how many/much"
Precipitating Factors�"what makes it worse"
Alleviating Factors�"what makes it better"
Can also u
Allergies/Sensitivities
Remember, any substance has the potential to cause a reaction. Ask about:
� Foods: eggs (vaccinations), shellfish (iodine), peanuts, lactose intolerance, meat (vaccinations and insulin)
� Medications: especially the ones used to TREAT allergic reactions (
Medication Allergies
Penicillins: MAY tolerate 2nd/3rd generation cephalosporins, use with caution; also use aminoglycosides, quinolones, macrolides, and tetracyclines
� Cephalosporins: Avoid any of the "Cef-" or "-ceph-" meds (ceftriaxone, cefixime)
� Sulfa: avoid any of the
Common Age-Related Changes
� Brain: mild cognitive impairment, slower reflexes
� Bones/Joints: weaker bones, worn-down cartilage in joints
� Muscles: decreased strength and coordination, less elastic ligaments
� Eyes: presbyopia, cataracts, macular degeneration, dry eyes, yellowed
Psychosocial Assessment
Observed/Visual components: appearance, demeanor, communication style, thought processes, overt behaviors, and reports from family or other practitioners
Verbal components: name, birth order in family, adoption, past developmental history, international i
Delegation
What it is:
Process of assigning responsibility or activities to another; usually from a boss or superior to underlings
Nursing application:
A charge nurse will delegate the narcotics count to two other RNs.
An RN will delegate oral medication administrat
Therapeutic Interviewing
� Focus on the present, not the past
� Identify alternatives and choices, instead of providing solutions
� Use broad statements or questions, "Is there something you would like to discuss?"
� Use general leads like "yes," "uh huh," "I see," nodding, atten
Therapeutic Interviewing Don'ts
DO NOT:
� Use clich�s or stereotyped comments; "It will all work out"; "You'll be home in no time"
� Give advice; "You should..."
� Give approval; sets up a standard of acceptability; "You did the right thing."
� Ask "why"; encourages invention of answers
Suicide Screening
Look for: depressed mood (or sudden elevated mood after being depressed),
unusually fast or slow movements, patient expressions of suicide or finality ("I
won't be around to deal with that."), unusual expression of anger
Ask about: changes in weight, slee
Abuse Screening
Look for: expression of fear, anxiety, depression, and/or anger; flat affect; loss of
appetite; injuries inconsistent or improbable to story; chronic pelvic pain, headaches, vaginitis, IBS, guarding
Ask about: activities or actions of others that make the
Complementary Therapies
� Cognitive behavioral therapy (CBT): alters perception, increases sense of control,
and decreases maladaptive behaviors
� Biofeedback: teaches voluntary control over body physiology
� Relaxation: includes deep breathing, muscle relaxation exercises, and
Herbs and Vitamins
The nurse should obtain the types and amounts of herbal substances used by
the patient and inform the healthcare team of the patient's choice so adverse
reactions can be avoided.
May increase clotting times (stop 10-14 days prior to surgery):
Ginger, Onio
Homeopathy
What it is:
Treatment of disease or symptomology by using very small doses of natural
substances that, given in larger amounts, would cause disease symptoms in a
healthy person; "like cures like"; assumes that the body has the ability to heal
itself.
Nurs
Nutrition Assessment
Deficiency signs and symptoms:
Vit A: dry eyes, slow growth rate, increased infections, infertility, VAD anemia
Vit B: painful fissured tongue, greasy scaly facial skin, peripheral neuropathy, cognitive
disturbances
Vit C: nosebleeds, bleeding gums, plugg
Pain Assessment
Similar to the "History of Present Illness" interview:
� Location
� Onset
� Quality
� Intensity (use appropriate Pain Scale)
� Duration
� Frequency
� Precipitating factors
� Alleviating factors
� Associated symptoms
� Changes to ADLs
Pain
Acute Pain:
� Nerves warn of impending or actual tissue damage and place body systems
on alert; increased blood pressure, heart rate, and respirations, diaphoresis,
grimacing.
Chronic Pain:
� Nervous system adapts, and acute symptoms may not appear.
� Pat
Heart Sounds
� Best heard when patient is supine or lying on left side
� Valves shut in pairs: mitral and tricuspid; pulmonic and aortic
� S1 is the closure of the mitral and tricuspid valves (start of systole); best
heard over 5th intercostal, midclavicular line
� S2
Circulation
Vena Cava > Right Atrium > Tricuspid Valve > Right Ventricle
Pulmonic Valve > Pulmonary Arteries > Pulmonary Veins > Left Atrium
Mitral Valve > Left Ventricle > Aortic Valve > Aorta
Arteries, Arterioles > Capillaries > Venules, Veins > Vena Cav
Lung Sounds
� Tracheal: high-pitched; heard over trachea
� Bronchial: high-pitched and loud; heard next to trachea
� Bronchovesicular: mid-pitch, med volume; heard next to sternum and
between scapula
� Vesicular: low-pitched, soft; heard over lung fields
� Crackles (
Respiratory Patterns
� Cheyne-Stokes: apnea, crescendo/decrescendo rate and depth of
breaths, then apnea; indicates damage to respiratory brain centers (stroke,
TBI, metabolic encephalopathy), carbon monoxide poisoning, chronic
heart failure, adjustments to altitude changes,
Ventilation Pathway
Nose/ Mouth (naso-/oropharynx) > Laryngopharynx, Epiglottis,
Larynx, Trachea
Carina > Lt and Rt Mainstem Bronchus > Lobar Bronchi > Tertiary
Bronchi
Terminal Bronchioles > Respiratory Bronchioles > Alveolar Ducts > Alveoli (300M)
The right lung has 3 lobe
Bowel Sounds
Begin in LRQ and move clockwise; listen up to 5 minutes in each quadrant. Bowel sounds should be evaluated in light of other GI symptoms.
� Normal: more active prior to a meal
� Hypoactive: normal during sleep and after surgery or spinal anesthesia;
may i
PERRLA
Pupils are:
� Equal: the size of both the pupils is the same; different sizes may indicate
anisocoria, disorders of cranial nerve III or autonomic nervous system
(Question to ask: does the larger or the smaller pupil represent the
problem?)
� Round: shape
Level of Consciousness (LOC)
LOC can be evaluated using several tools such as Glasgow Coma Scale (GCS), FOUR, or AVPU. In general, these tools evaluate some or all of the following:
� Cognition/Orientation: is the patient aware of the correct date, time, and place?
� Ability to follo
Grading Edema
+1 - Barely detectable impression; ~2mm
+2 - Slight indentation, ~4mm; 15 seconds to rebound
+3 - Deeper indentation, ~6mm; 30 seconds to rebound
+4 - Indentation takes >30 sec to rebound: ~8mm
Pulse Oximeter
Used for: obtaining arterial oxygen saturation readings and pulse rates
Oxygen saturation: the percentage of hemoglobin molecules that have all four spaces for oxygen molecules full; if all hemoglobin molecules are fully saturated, the reading is 100%
Alt
Patient Safety
How to prevent:
� Diagnostic errors: obtain complete and accurate patient Hx, HPI, and headto-toe assessment; thoroughly document all findings
� Medication errors: question poorly written orders; use Five Rights without fail; look up meds that are unfamil
Physical Therapy (PT)
What it is:
Branch of rehabilitation science that focuses on improving physical function, movement, and flexibility of bones, muscles, and joints; may improve weakness, stiffness, low exercise tolerance, gait, posture, and ergonomics as well as relieve pa
Occupational Therapy (OT)
What it is:
Branch of rehabilitation science that focuses on improving patient's abilities with daily living activities and independence (e.g., using crutches, how to accommodate limitations caused by illness or injury, correcting delays in childhood deve
Respiratory Therapy (RT)
What it is:
Branch of rehabilitation science that focuses on improving the health and strength of the respiratory system, including musculature, ventilation, oxygenation, and perfusion of the alveolar bed.
Nursing Application:
RT works closely with nursin
Family Conference
What it is:
A meeting with the patient, family, and health care team to exchange information, update the plan of care, review family goals and resources, and facilitate communication among all parties involved; a nursing intervention as defined by NIC ter
Care Conference
What it is:
A gathering of multidisciplinary health professionals to plan and evaluate patient care; does not include patient or family.
Nursing Application:
A care conference is called instead of a family conference when some conflict or lack of directio
Community Resource
What it is:
A person, agency, facility, company, or service separate from medical facilities that fills a need for persons who may have limited personal resources; these resources generally fill needs for housing, food, medical supplies or medications, le
Diversity
What it is:
The variations among the population; can refer to age, sexual preference, languages, ethnicity, religious and spiritual beliefs and practices, cultural practices, gender roles, communication patterns, views on afterlife, work ethics, ethics in
Family Dynamics
What they are:
Patterns of interactions among family members; forces within the family that produce certain behaviors and symptoms. Usually these dynamics relate in some part to the goals and desires of each individual family member.
Nursing Application:
Quality Improvement (QI)
What it is:
The process of analyzing data about performance and outcomes, and initiating efforts to improve both performance and outcomes.
Nursing Application:
High-quality patient care is largely dependent on the effective use of nursing resources within
Quality Assurance (QA)
What it is:
Monitoring and evaluating the processes and outcomes initiated by QI to ensure that the desired level of quality is consistently produced.
Nursing Application:
QA is at the heart of the phrase "Don't blame the person; blame the process."QA ass
Coping Strategy
What it is:
A conscious or unconscious response to negative life experiences such as stress, grief, loss, injury, loneliness, or invasion of privacy; positive and negative coping strategies exist and may become barriers to health promotion.
Nursing Applic
Management Terms
Utilization review: the detailed evaluation of health-care services provided to patients for necessity and cost-effectiveness; also monitors quality of care
Risk management: the process of identifying, assessing, and prioritizing risks; goal is to prevent
Trend Data Analysis (TDA)
What it is:
The use of past and/or present data to predict future problems, outcomes, costs, and more by identifying and monitoring trends.
Nursing Application:
TDA is used heavily in the nursing field. Everything from error trends related to length of nu
Conflict Resolution
What it is:
The process of facilitating a peaceful end to conflict and retribution; closely connected with the concept of negotiation.
Nursing Application:
Conflict usually results from deep personal needs, known or unknown. These needs can be correlated
HIPAA
What it is:
� The Health Insurance Portability and Accountability Act of 1996
� Title I: regulates restrictions on individual insurance policies regarding preexisting conditions; limited-coverage plans (dental, vision) are exempt from HIPAA requirements u
OBRA
What it is:
� Omnibus Budget Reconciliation Act of 1987 (Nursing Home Reform Act)
� Regulates nursing home and long-term facility quality of care, care planning, and assessment
� Includes 15 primary regulatory categories (urinary catheters, nutrition, ass
Institute of Medicine (IOM)
What it is:
A non-profit, non-government organization designed to provide advice on health, medicine, and biomedical science; relies on a peer-reviewed network of volunteer scientists and experts who are elected annually by current members; as of 2014, th
Bandura and Self-Efficacy
What it is:
Per psychologist Albert Bandura, self-efficacy is a person's belief in their innate abilities to succeed in a given situation; this belief is influenced by behaviors, environment, and cognitive factors (how a person thinks).
Nursing Applicatio
Health Belief Model
What it is:
� A theory developed by social psychologists in the 1950s to explain and predict health-related behaviors (for that time, specifically why screening programs for tuberculosis were not successful); includes 4 main perceptions: Perceived serious
Change Management Model
What it is:
A model developed by Kurt Lewin in the 1950s that describes the three-stage process of change like that of an ice block: Unfreeze, Change, Refreeze.
Nursing Application:
� Unfreeze: the status-quo is challenged (by poor survey results, new res
Crisis Safety Plan
What it is:
A plan of action designed to be implemented when a person feels or acts "in crisis" whether that crisis be an exacerbation of a mental condition or an escalation of suicide intent, substance abuse, or domestic violence.
Nursing Application:
De
Respite Care
What it is:
Temporary care of a dependent person in order to provide relief or "respite" for usual caregivers (family members); care may last from just a few hours up to a week or more.
Nursing Application:
Respite care reduces the risk of caregiver burno
Epidemiology
What it is:
A branch of medicine that calculates incidence and distribution of diseases and other health factors; also deals with addressing possible controls for diseases.
Nursing Application:
The term "risk factors" is key in epidemiology. Certain popul
Elevated Risk per Population
African/African-American: HTN, sickle-cell anemia, diabetes, stroke
Carribean: stroke
Hispanic: colon cancer, liver disease, diabetes
Asian: heart disease, cancer, diabetes, Kawasaki disease (Indian Asian)
Mediterranean: Thalassemia, sickle-cell anemia
Je
Managing Anticoagulants
Examples: warfarin (Coumadin), heparin, enoxaparin (Lovenox)
Actions: alter chemical reactions among clotting factors to extend the time it takes to form a clot
Routes: PO (warfarin and others), SQ (enoxaparin), SQ/IV (heparin)
Dose weight-based? No, titr
Managing Antiplatelets
Examples: aspirin, clopidogrel (Plavix), prasugrel (Effient), ticagrelor (BRILINTA), ticlopidine
Actions: prevent clumping of platelets into a clot
Routes: PO
Dose weight-based? No
Watch for: signs of GI bleeding, back pain, jaundice, low platelet counts
Managing Antihypertensives
Examples: diuretics, beta-adrenergic blockers (beta blockers), renin inhibitors (aliskiren), ACE inhibitors, ARBs, calcium channel blockers, alpha blockers, central agonists, direct vasodilators (hydralazine), adrenergic antagonists, nitroprusside
Actions
Managing Diuretics
Examples: carbonic anhydrase inhibitors, thiazides (HCTZ), thiazide-like (chlorthalidone, metolazone), loop (bumetanide, furosemide, torsemide), and potassium-sparing (amiloride, spirinolactone, triamterene)
Actions: alter the way the kidney filters, reab
Managing ACE Inhibitors
Examples: benazepril, captopril, lisinopril, any other -pril medication
Actions: inhibits angiotensin-converting enzyme, thus reducing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; increase synthesis of prostaglandins
Routes: PO
Managing ARBs
Examples: losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar)
Actions: lower BP by blocking the binding of angiotensin II to receptors
Routes: PO, IV
Dose weight-based? No for adults
Watch for: hyperkalemia
Contraindicated: with unilateral/bilater
Managing Lipid-lowering Agents
Examples: atorvastatin (Lipitor), niacin/simvastatin (Simcor), fenofibrate (Tricor), gemfibrozil (Lopid), exetimibe (Zetia), cholestyramine/sucrose (Questran)
Actions: lower cholesterol levels by reducing absorption, preventing the body from making choles
Managing Antidepressants
Examples: tricyclics [amitriptyline (Elavil)], SSRIs [citolapram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)], MAO inhibitors [phenelzine (Nardil)], serotonin-norepinephrine reuptake inhibitors [venlafaxine (Effexor), duloxetine
Managing Insulin
Examples: very rapid acting (Humalog), rapid acting (Novolog, Humulin R, Novolin R), intermediate (NPH: Novolin N, Humulin N and Lente: Novolin L and Humulin L), long acting (Humulin U, Lantus, Levelin), combination (NPH/Reg 70/30, 51/50 and Humalog mix 7
Insulin Effects
Type Onset (hours) Peak (hours) Duration (hours)
Very Rapid (lispro) <0.5 0.5-3 3-5
Short Acting 0.5 1-5 8
Intermediate 1-4 4-15 14-26
Long Acting
Humulin U 4-6 8-20 24-36
Lantus 1-2 None 24
Levelin 1 6-8 20
Combination
NPH/Regular 70-30 0.5-3 Dual 12-14
Managing Antibiotics
Examples: multiple; over 20 categories of antimicrobials
Actions: block vital processes of, stop multiplication of, or kill bacteria
Routes: PO, IM, IV, topical, ophthalmic, otic
Adult dose weight-based? No; however, obese patients may require doses on th
Managing Oxygen Therapy
Examples: blow-by, nasal cannula, face mask, nonrebreather mask, Venturi mask,
CPAP/BiPAP, humidified O2, bag-valve-mask (BVM), ventilator settings
Actions: increases the ratio of oxygen to other gases in the air inhaled by
patients; goal is to increase o
Vaccinations
Examples: anthrax, Hep A, Hep B, Hib, HPV, influenza, MMR, polio, rabies, Td
Actions: trigger systemic immune response to a designated pathogen
Routes: PO, SQ (MMR, MPSV, zoster, varicella), IM, ID (Fluzone intradermal), IN
(FluMist/LAIV)
Dose weight-base
Managing Compression Devices
Types: thrombo-embolic deterrent (TED) hose, sequential compression devices
(SCDs), compression stockings
Used for: TED hose and SCDs (reducing risk of DVTs); compression stockings
(improving venous return, decreasing lymphedema)
Contraindications: Do NOT
Managing Hot/Cold Therapies
Types: hot water bottle, heating pad, ice pack, Bair blankets, cooling blankets
Used for: pain relief/local analgesia, improving circulation, relaxation, swelling
relief, external means of altering a patient's internal temperature
Contraindications: direc
Managing Physical Restraints
Types: wrist/ankle cuffs (soft and leather); safety vest, bed rails, other physical
restraint devices ; also classified into "Medical/Surgical restraints" and
"Behavioral restraints"
Used for: safety; preventing the patient from removing or damaging clini
Nursing Care: Blood Transfusions
Consent Req? Yes; consent is implied in emergency situations
Nsg Duties prior: assess for prior hx of blood infusion reactions and for
practicing Jehovah's Witnesses, large-bore IV access (at least 20G for PRBCs),
filtered blood admin IV set primed with n
Nursing Care: X-Rays
Consent Req? Admission consent sufficient
Nsg Duties prior: assess allergies to shellfish or iodine if dye to be
administered, insert IV for dye; have pt remove metal objects; ensure
reproductive organs and thyroid are covered with lead shield; educate pa
Nursing Care: CT Scan
Consent Req? Admission consent sufficient
Nsg Duties prior: assess risk for claustrophobia and allergies to shellfish or
iodine if dye to be administered, insert IV for dye; have pt remove metal
objects; NPO status 3-8 hrs prior if dye to be used; adminis
Nursing Care: MRI
Consent Req? Admission consent sufficient
Nsg Duties prior: assess for any external or internal metal, including
pacemakers, administer anxiolytic as needed; advise pt to expect small space
with loud clicking sounds
Nsg Duties during: monitor for complica
Nursing Care: Percutaneous Liver Biopsy
Consent Req? Yes (percutaneous biopsy)
Nsg Duties prior: assess for bleeding risk; IV access; ensure pt has toileted;
NPO 4 hrs prior
Nsg Duties during: instruct pt to exhale and hold while needle inserted
Nsg Duties after: apply pressure dsg; instruct pt
Infection Risk
What it is:
"Risk of infection" is a frequent nursing diagnosis used to identify patients at
risk of acquiring a opportunistic, nosocomial, pathogenic, or communityrelated
pathogen.
Nursing Application:
Specific nosocomial infection risks are addressed by
Discharge Planning
What it is:
The process that facilitates the movement of patients between facilities or
from a facility to home/home care; the goal is enhance continuity of care; the
key to successful discharge planning is multidisciplinary communication.
Nursing Applica
Legislation
The Civil Rights Act of 1964: outlaws discrimination based on gender, race,
color, religion, or national origin; ended racial segregation in public facilities;
prevents discrimination by agencies that receive federal funds
� The Rehabilitation Act of 1973
Healthy People 2020 Initiatives
What it is:
10-year National health objectives designed to address the most significant
preventable health threats; plan includes 42 topic areas, with heavy emphasis
on heart disease and stroke prevention; find more info at healthypeople.gov.
Nursing Appl
Appendicitis
Possible Causes: bowel cancer, infection, barium ingestion, fecal mass
Notable symptoms: RLQ abd pain, fever, tachycardia, N/V, Rovsing's sign
Diagnostic Test(s): elevated WBCs, abd U/S, CT scan
Nursing Dx: Acute Pain, Risk for infection
Nursing Tx: Fowle
Cholecystitis
Possible Causes: gallstones, bacterial infection
Symptoms: sharp RUQ abd pain; referred pain to right shoulder, N/V, positive Murphy's sign
Dx Test(s): abd U/S, serum alk phos, lactate, AST/SGOT and bilirubin elevated
Nursing Dx: Acute Pain, Risk for infe
Liver Cirrhosis
Possible Causes: alcohol, hepatitis, toxins, gallbladder disease, hemochromatosis, right-sided heart failure
Notable symptoms: enlarged liver, N/V, diarrhea or constipation, flatulence, dull abd pain, weight loss
Diagnostic test(s): liver biopsy, liver fu
Nursing Code of Conduct
� Participating in intra-professional collaboration
� Avoiding conflicts of interests
� Maintaining respect for human dignity
� Integrating professional values with personal values
The Code of Ethics from the American Nurses Association (ANA) states in
po
Nursing Ethics
Ethics: moral principles that govern behavior; ideal, standards
Principles:
� Autonomy: duty to allow patient to make independent decisions
� Veracity: duty to tell the truth
� Fidelity: duty to keep promises and commitments
� Justice: duty to provide equ
Ethical Dilemmas
Issues surrounding quality-of-life, end-of life, and DNR orders most often
trigger ethical dilemmas, when no clear course of action is apparent.
Obtain a referral to ethics committee for disagreements about treatments:
� Between family members
� Among hea
Advocacy
What it is: action or series of actions that argues for, speaks in favor of,
recommends, or supports another person, place, or thing
Nursing Advocacy:
� Integrates individuality, professionalism, and empowering
� Involves a process of analyzing, counselin
Kubler-Ross Stages of Grief
Patients, families, and other caregivers can progress through these stages.
� Denial: avoiding the inevitable
� Anger: expressing emotions previously bottled-up
� Bargaining: trying to find a way out
� Depression: acknowledging the inevitable
� Acceptance
Leadership Styles
Autocratic: unilateral, dictatorial, works toward single goal; meets resistance
from mature, experienced staff
Democratic/participative: team approach, staff participation, retains responsibility for outcome
Laissez-faire: little control; leaves decision
Shared Governance
What it is:
� A model of nursing practice designed to improve work environment, satisfaction, and nurse retention
� Champions staff as most important asset of organization
� Encourages autonomy, empowerment, involvement, and participation
� Teams and grou
Adult Learning
The education process should reflect the nursing process (assess, plan, implement, evaluate)
� Multiple sensory avenues for learning increases learning and retention.
� Doing and saying (teach-back) is more effective than reading and hearing.
� Learning n
Learning Barriers
Physical Impairments: inadequacies of the five senses; impaired mobility
� Cognitive: mental disability or impairment; dyslexia, phobias
� Language: aphasic; lack of fluency, reads at less than 8th grade level
� Emotional: fear/superstitions, anxiety, dep
Teaching Strategies�Adults
Assess: mental and physical capabilities, perception of the problem, preferred
learning style
Plan: establish mutual goals with patient that are specific, practical, attainable, relevant, and culturally sensitive
Intervene: use multiple methods to enhance
Maslow's Hierarchy of Needs
Physiological: basic needs such as air, water, food, shelter, and freedom from pain (comfort)
Safety: free from harm or threat of harm; stability
Love/Belonging: friendship, acceptance, affection; support system
Esteem: self-respect, self-confidence, rewa
Nursing Diagnoses, Domains
NANDA-II taxonomy, 13 Domains (47 Classes, 216 Diagnoses)
� Activity/Rest
� Comfort
� Coping/Stress Tolerance
� Elimination
� Growth/Development
� Health Promotion
� Life Principles
� Nutrition
� Perception/Cognition
� Role Relationships
� Safety/Protecti
Nursing Diagnoses, Format
Diagnosis: (example) Imbalanced nutrition: Less than body requirements
Related to: (example) Insufficient caloric intake
Evidenced by: (example) Weight loss
Expected Outcomes: (example) The patient will achieve and maintain adequate weight (use NOC termin
Nursing Intervention Classification
What it is:
A list of 554 interventions (in 2013 6th ed.) that nurses perform; includes direct, indirect, collaborative, and independent interventions that address both physiologic and psychosocial aspects of patient care. Interventions fall into three ca
Nursing Outcomes Classification
What it is:
A system which describes patient outcomes sensitive to nursing intervention; includes 490 outcomes in the 5th edition (2013); a means of standardizing nursing language used in the nursing process, similar to NANDA for
diagnoses, and NIC for nu
Problem Prioritization
What it is:
A means of focusing nursing interventions on the most important patient problems; usually follows Maslow's Hierarchy and the ABCDE mnemonic.
Nursing Application:
Once immediate ABC needs are met, the patient and family should participate
in fo
Collaboration
What it is:
A dynamic process that produces a synthesis of perspectives and shared responsibilities to address a problem set that cannot be handled by a single individual
Nursing Application:
The team approach is essential to patient care. Collaboration a
Core Measures
Standards of care that improve patient care and outcomes
� Data is submitted to CMS (Medicaid/ Medicare) and TJC
� Includes reports on diseases/conditions seen, hospital-acquired conditions, Emergency Department (ED) care, and the Surgical Care Improvemen
Core Measures: Reportable HospitalAcquired Conditions
Foreign object retained after surgery
� Air embolism
� Blood incompatibility
� Stage 3 and 4 pressure ulcers
� Falls and other traumas
� CAUTIs (urinary catheter infections)
� Vascular catheter-associated infections
� Manifestations of poor glycemic contr
Core Measures: Prevention
Core Measures also address prevention. Sets of data collected are listed.
� Immunization (IMM): pneumococcal immunization rates for overall, age 65+, and high-risk groups ages 5-65; influenza immunization rates
� Tobacco Cessation (TOB): screening, treatm
Health History Components
Biographical info (demographics): patient registration form, psychosocial data
� Chief complaint (CC): reason for visit; patient's exact words; include how long complaint has been going on (i.e., "belly's been hurting for two days")
� Health History (HPI,
HPI Details
Under HPI (history of present illness), include the following:
Onset�"when"
Duration�"how long"
Location�"where"
Quality�"what type"
Quantity�"how many/much"
Precipitating Factors�"what makes it worse"
Alleviating Factors�"what makes it better"
Can also u
Allergies/Sensitivities
Remember, any substance has the potential to cause a reaction. Ask about:
� Foods: eggs (vaccinations), shellfish (iodine), peanuts, lactose intolerance, meat (vaccinations and insulin)
� Medications: especially the ones used to TREAT allergic reactions (
Medication Allergies
Penicillins: MAY tolerate 2nd/3rd generation cephalosporins, use with caution; also use aminoglycosides, quinolones, macrolides, and tetracyclines
� Cephalosporins: Avoid any of the "Cef-" or "-ceph-" meds (ceftriaxone, cefixime)
� Sulfa: avoid any of the
Common Age-Related Changes
� Brain: mild cognitive impairment, slower reflexes
� Bones/Joints: weaker bones, worn-down cartilage in joints
� Muscles: decreased strength and coordination, less elastic ligaments
� Eyes: presbyopia, cataracts, macular degeneration, dry eyes, yellowed
Psychosocial Assessment
Observed/Visual components: appearance, demeanor, communication style, thought processes, overt behaviors, and reports from family or other practitioners
Verbal components: name, birth order in family, adoption, past developmental history, international i
Delegation
What it is:
Process of assigning responsibility or activities to another; usually from a boss or superior to underlings
Nursing application:
A charge nurse will delegate the narcotics count to two other RNs.
An RN will delegate oral medication administrat
Therapeutic Interviewing
� Focus on the present, not the past
� Identify alternatives and choices, instead of providing solutions
� Use broad statements or questions, "Is there something you would like to discuss?"
� Use general leads like "yes," "uh huh," "I see," nodding, atten
Therapeutic Interviewing Don'ts
DO NOT:
� Use clich�s or stereotyped comments; "It will all work out"; "You'll be home in no time"
� Give advice; "You should..."
� Give approval; sets up a standard of acceptability; "You did the right thing."
� Ask "why"; encourages invention of answers
Suicide Screening
Look for: depressed mood (or sudden elevated mood after being depressed),
unusually fast or slow movements, patient expressions of suicide or finality ("I
won't be around to deal with that."), unusual expression of anger
Ask about: changes in weight, slee
Abuse Screening
Look for: expression of fear, anxiety, depression, and/or anger; flat affect; loss of
appetite; injuries inconsistent or improbable to story; chronic pelvic pain, headaches, vaginitis, IBS, guarding
Ask about: activities or actions of others that make the
Complementary Therapies
� Cognitive behavioral therapy (CBT): alters perception, increases sense of control,
and decreases maladaptive behaviors
� Biofeedback: teaches voluntary control over body physiology
� Relaxation: includes deep breathing, muscle relaxation exercises, and
Herbs and Vitamins
The nurse should obtain the types and amounts of herbal substances used by
the patient and inform the healthcare team of the patient's choice so adverse
reactions can be avoided.
May increase clotting times (stop 10-14 days prior to surgery):
Ginger, Onio
Homeopathy
What it is:
Treatment of disease or symptomology by using very small doses of natural
substances that, given in larger amounts, would cause disease symptoms in a
healthy person; "like cures like"; assumes that the body has the ability to heal
itself.
Nurs
Nutrition Assessment
Deficiency signs and symptoms:
Vit A: dry eyes, slow growth rate, increased infections, infertility, VAD anemia
Vit B: painful fissured tongue, greasy scaly facial skin, peripheral neuropathy, cognitive
disturbances
Vit C: nosebleeds, bleeding gums, plugg
Pain Assessment
Similar to the "History of Present Illness" interview:
� Location
� Onset
� Quality
� Intensity (use appropriate Pain Scale)
� Duration
� Frequency
� Precipitating factors
� Alleviating factors
� Associated symptoms
� Changes to ADLs
Pain
Acute Pain:
� Nerves warn of impending or actual tissue damage and place body systems
on alert; increased blood pressure, heart rate, and respirations, diaphoresis,
grimacing.
Chronic Pain:
� Nervous system adapts, and acute symptoms may not appear.
� Pat
Heart Sounds
� Best heard when patient is supine or lying on left side
� Valves shut in pairs: mitral and tricuspid; pulmonic and aortic
� S1 is the closure of the mitral and tricuspid valves (start of systole); best
heard over 5th intercostal, midclavicular line
� S2
Circulation
Vena Cava > Right Atrium > Tricuspid Valve > Right Ventricle
Pulmonic Valve > Pulmonary Arteries > Pulmonary Veins > Left Atrium
Mitral Valve > Left Ventricle > Aortic Valve > Aorta
Arteries, Arterioles > Capillaries > Venules, Veins > Vena Cav
Lung Sounds
� Tracheal: high-pitched; heard over trachea
� Bronchial: high-pitched and loud; heard next to trachea
� Bronchovesicular: mid-pitch, med volume; heard next to sternum and
between scapula
� Vesicular: low-pitched, soft; heard over lung fields
� Crackles (
Respiratory Patterns
� Cheyne-Stokes: apnea, crescendo/decrescendo rate and depth of
breaths, then apnea; indicates damage to respiratory brain centers (stroke,
TBI, metabolic encephalopathy), carbon monoxide poisoning, chronic
heart failure, adjustments to altitude changes,
Ventilation Pathway
Nose/ Mouth (naso-/oropharynx) > Laryngopharynx, Epiglottis,
Larynx, Trachea
Carina > Lt and Rt Mainstem Bronchus > Lobar Bronchi > Tertiary
Bronchi
Terminal Bronchioles > Respiratory Bronchioles > Alveolar Ducts > Alveoli (300M)
The right lung has 3 lobe
Bowel Sounds
Begin in LRQ and move clockwise; listen up to 5 minutes in each quadrant. Bowel sounds should be evaluated in light of other GI symptoms.
� Normal: more active prior to a meal
� Hypoactive: normal during sleep and after surgery or spinal anesthesia;
may i
PERRLA
Pupils are:
� Equal: the size of both the pupils is the same; different sizes may indicate
anisocoria, disorders of cranial nerve III or autonomic nervous system
(Question to ask: does the larger or the smaller pupil represent the
problem?)
� Round: shape
Level of Consciousness (LOC)
LOC can be evaluated using several tools such as Glasgow Coma Scale (GCS), FOUR, or AVPU. In general, these tools evaluate some or all of the following:
� Cognition/Orientation: is the patient aware of the correct date, time, and place?
� Ability to follo
Grading Edema
+1 - Barely detectable impression; ~2mm
+2 - Slight indentation, ~4mm; 15 seconds to rebound
+3 - Deeper indentation, ~6mm; 30 seconds to rebound
+4 - Indentation takes >30 sec to rebound: ~8mm
Pulse Oximeter
Used for: obtaining arterial oxygen saturation readings and pulse rates
Oxygen saturation: the percentage of hemoglobin molecules that have all four spaces for oxygen molecules full; if all hemoglobin molecules are fully saturated, the reading is 100%
Alt
Patient Safety
How to prevent:
� Diagnostic errors: obtain complete and accurate patient Hx, HPI, and headto-toe assessment; thoroughly document all findings
� Medication errors: question poorly written orders; use Five Rights without fail; look up meds that are unfamil
Physical Therapy (PT)
What it is:
Branch of rehabilitation science that focuses on improving physical function, movement, and flexibility of bones, muscles, and joints; may improve weakness, stiffness, low exercise tolerance, gait, posture, and ergonomics as well as relieve pa
Occupational Therapy (OT)
What it is:
Branch of rehabilitation science that focuses on improving patient's abilities with daily living activities and independence (e.g., using crutches, how to accommodate limitations caused by illness or injury, correcting delays in childhood deve
Respiratory Therapy (RT)
What it is:
Branch of rehabilitation science that focuses on improving the health and strength of the respiratory system, including musculature, ventilation, oxygenation, and perfusion of the alveolar bed.
Nursing Application:
RT works closely with nursin
Family Conference
What it is:
A meeting with the patient, family, and health care team to exchange information, update the plan of care, review family goals and resources, and facilitate communication among all parties involved; a nursing intervention as defined by NIC ter
Care Conference
What it is:
A gathering of multidisciplinary health professionals to plan and evaluate patient care; does not include patient or family.
Nursing Application:
A care conference is called instead of a family conference when some conflict or lack of directio
Community Resource
What it is:
A person, agency, facility, company, or service separate from medical facilities that fills a need for persons who may have limited personal resources; these resources generally fill needs for housing, food, medical supplies or medications, le
Diversity
What it is:
The variations among the population; can refer to age, sexual preference, languages, ethnicity, religious and spiritual beliefs and practices, cultural practices, gender roles, communication patterns, views on afterlife, work ethics, ethics in
Family Dynamics
What they are:
Patterns of interactions among family members; forces within the family that produce certain behaviors and symptoms. Usually these dynamics relate in some part to the goals and desires of each individual family member.
Nursing Application:
Quality Improvement (QI)
What it is:
The process of analyzing data about performance and outcomes, and initiating efforts to improve both performance and outcomes.
Nursing Application:
High-quality patient care is largely dependent on the effective use of nursing resources within
Quality Assurance (QA)
What it is:
Monitoring and evaluating the processes and outcomes initiated by QI to ensure that the desired level of quality is consistently produced.
Nursing Application:
QA is at the heart of the phrase "Don't blame the person; blame the process."QA ass
Coping Strategy
What it is:
A conscious or unconscious response to negative life experiences such as stress, grief, loss, injury, loneliness, or invasion of privacy; positive and negative coping strategies exist and may become barriers to health promotion.
Nursing Applic
Management Terms
Utilization review: the detailed evaluation of health-care services provided to patients for necessity and cost-effectiveness; also monitors quality of care
Risk management: the process of identifying, assessing, and prioritizing risks; goal is to prevent
Trend Data Analysis (TDA)
What it is:
The use of past and/or present data to predict future problems, outcomes, costs, and more by identifying and monitoring trends.
Nursing Application:
TDA is used heavily in the nursing field. Everything from error trends related to length of nu
Conflict Resolution
What it is:
The process of facilitating a peaceful end to conflict and retribution; closely connected with the concept of negotiation.
Nursing Application:
Conflict usually results from deep personal needs, known or unknown. These needs can be correlated
HIPAA
What it is:
� The Health Insurance Portability and Accountability Act of 1996
� Title I: regulates restrictions on individual insurance policies regarding preexisting conditions; limited-coverage plans (dental, vision) are exempt from HIPAA requirements u
OBRA
What it is:
� Omnibus Budget Reconciliation Act of 1987 (Nursing Home Reform Act)
� Regulates nursing home and long-term facility quality of care, care planning, and assessment
� Includes 15 primary regulatory categories (urinary catheters, nutrition, ass
Institute of Medicine (IOM)
What it is:
A non-profit, non-government organization designed to provide advice on health, medicine, and biomedical science; relies on a peer-reviewed network of volunteer scientists and experts who are elected annually by current members; as of 2014, th
Bandura and Self-Efficacy
What it is:
Per psychologist Albert Bandura, self-efficacy is a person's belief in their innate abilities to succeed in a given situation; this belief is influenced by behaviors, environment, and cognitive factors (how a person thinks).
Nursing Applicatio
Health Belief Model
What it is:
� A theory developed by social psychologists in the 1950s to explain and predict health-related behaviors (for that time, specifically why screening programs for tuberculosis were not successful); includes 4 main perceptions: Perceived serious
Change Management Model
What it is:
A model developed by Kurt Lewin in the 1950s that describes the three-stage process of change like that of an ice block: Unfreeze, Change, Refreeze.
Nursing Application:
� Unfreeze: the status-quo is challenged (by poor survey results, new res
Crisis Safety Plan
What it is:
A plan of action designed to be implemented when a person feels or acts "in crisis" whether that crisis be an exacerbation of a mental condition or an escalation of suicide intent, substance abuse, or domestic violence.
Nursing Application:
De
Respite Care
What it is:
Temporary care of a dependent person in order to provide relief or "respite" for usual caregivers (family members); care may last from just a few hours up to a week or more.
Nursing Application:
Respite care reduces the risk of caregiver burno
Epidemiology
What it is:
A branch of medicine that calculates incidence and distribution of diseases and other health factors; also deals with addressing possible controls for diseases.
Nursing Application:
The term "risk factors" is key in epidemiology. Certain popul
Elevated Risk per Population
African/African-American: HTN, sickle-cell anemia, diabetes, stroke
Carribean: stroke
Hispanic: colon cancer, liver disease, diabetes
Asian: heart disease, cancer, diabetes, Kawasaki disease (Indian Asian)
Mediterranean: Thalassemia, sickle-cell anemia
Je
Managing Anticoagulants
Examples: warfarin (Coumadin), heparin, enoxaparin (Lovenox)
Actions: alter chemical reactions among clotting factors to extend the time it takes to form a clot
Routes: PO (warfarin and others), SQ (enoxaparin), SQ/IV (heparin)
Dose weight-based? No, titr
Managing Antiplatelets
Examples: aspirin, clopidogrel (Plavix), prasugrel (Effient), ticagrelor (BRILINTA), ticlopidine
Actions: prevent clumping of platelets into a clot
Routes: PO
Dose weight-based? No
Watch for: signs of GI bleeding, back pain, jaundice, low platelet counts
Managing Antihypertensives
Examples: diuretics, beta-adrenergic blockers (beta blockers), renin inhibitors (aliskiren), ACE inhibitors, ARBs, calcium channel blockers, alpha blockers, central agonists, direct vasodilators (hydralazine), adrenergic antagonists, nitroprusside
Actions
Managing Diuretics
Examples: carbonic anhydrase inhibitors, thiazides (HCTZ), thiazide-like (chlorthalidone, metolazone), loop (bumetanide, furosemide, torsemide), and potassium-sparing (amiloride, spirinolactone, triamterene)
Actions: alter the way the kidney filters, reab
Managing ACE Inhibitors
Examples: benazepril, captopril, lisinopril, any other -pril medication
Actions: inhibits angiotensin-converting enzyme, thus reducing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; increase synthesis of prostaglandins
Routes: PO
Managing ARBs
Examples: losartan (Cozaar), valsartan (Diovan), olmesartan (Benicar)
Actions: lower BP by blocking the binding of angiotensin II to receptors
Routes: PO, IV
Dose weight-based? No for adults
Watch for: hyperkalemia
Contraindicated: with unilateral/bilater
Managing Lipid-lowering Agents
Examples: atorvastatin (Lipitor), niacin/simvastatin (Simcor), fenofibrate (Tricor), gemfibrozil (Lopid), exetimibe (Zetia), cholestyramine/sucrose (Questran)
Actions: lower cholesterol levels by reducing absorption, preventing the body from making choles
Managing Antidepressants
Examples: tricyclics [amitriptyline (Elavil)], SSRIs [citolapram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)], MAO inhibitors [phenelzine (Nardil)], serotonin-norepinephrine reuptake inhibitors [venlafaxine (Effexor), duloxetine
Managing Insulin
Examples: very rapid acting (Humalog), rapid acting (Novolog, Humulin R, Novolin R), intermediate (NPH: Novolin N, Humulin N and Lente: Novolin L and Humulin L), long acting (Humulin U, Lantus, Levelin), combination (NPH/Reg 70/30, 51/50 and Humalog mix 7
Insulin Effects
Type Onset (hours) Peak (hours) Duration (hours)
Very Rapid (lispro) <0.5 0.5-3 3-5
Short Acting 0.5 1-5 8
Intermediate 1-4 4-15 14-26
Long Acting
Humulin U 4-6 8-20 24-36
Lantus 1-2 None 24
Levelin 1 6-8 20
Combination
NPH/Regular 70-30 0.5-3 Dual 12-14
Managing Antibiotics
Examples: multiple; over 20 categories of antimicrobials
Actions: block vital processes of, stop multiplication of, or kill bacteria
Routes: PO, IM, IV, topical, ophthalmic, otic
Adult dose weight-based? No; however, obese patients may require doses on th
Managing Oxygen Therapy
Examples: blow-by, nasal cannula, face mask, nonrebreather mask, Venturi mask,
CPAP/BiPAP, humidified O2, bag-valve-mask (BVM), ventilator settings
Actions: increases the ratio of oxygen to other gases in the air inhaled by
patients; goal is to increase o
Vaccinations
Examples: anthrax, Hep A, Hep B, Hib, HPV, influenza, MMR, polio, rabies, Td
Actions: trigger systemic immune response to a designated pathogen
Routes: PO, SQ (MMR, MPSV, zoster, varicella), IM, ID (Fluzone intradermal), IN
(FluMist/LAIV)
Dose weight-base
Managing Compression Devices
Types: thrombo-embolic deterrent (TED) hose, sequential compression devices
(SCDs), compression stockings
Used for: TED hose and SCDs (reducing risk of DVTs); compression stockings
(improving venous return, decreasing lymphedema)
Contraindications: Do NOT
Managing Hot/Cold Therapies
Types: hot water bottle, heating pad, ice pack, Bair blankets, cooling blankets
Used for: pain relief/local analgesia, improving circulation, relaxation, swelling
relief, external means of altering a patient's internal temperature
Contraindications: direc
Managing Physical Restraints
Types: wrist/ankle cuffs (soft and leather); safety vest, bed rails, other physical
restraint devices ; also classified into "Medical/Surgical restraints" and
"Behavioral restraints"
Used for: safety; preventing the patient from removing or damaging clini
Nursing Care: Blood Transfusions
Consent Req? Yes; consent is implied in emergency situations
Nsg Duties prior: assess for prior hx of blood infusion reactions and for
practicing Jehovah's Witnesses, large-bore IV access (at least 20G for PRBCs),
filtered blood admin IV set primed with n
Nursing Care: X-Rays
Consent Req? Admission consent sufficient
Nsg Duties prior: assess allergies to shellfish or iodine if dye to be
administered, insert IV for dye; have pt remove metal objects; ensure
reproductive organs and thyroid are covered with lead shield; educate pa
Nursing Care: CT Scan
Consent Req? Admission consent sufficient
Nsg Duties prior: assess risk for claustrophobia and allergies to shellfish or
iodine if dye to be administered, insert IV for dye; have pt remove metal
objects; NPO status 3-8 hrs prior if dye to be used; adminis
Nursing Care: MRI
Consent Req? Admission consent sufficient
Nsg Duties prior: assess for any external or internal metal, including
pacemakers, administer anxiolytic as needed; advise pt to expect small space
with loud clicking sounds
Nsg Duties during: monitor for complica
Nursing Care: Percutaneous Liver Biopsy
Consent Req? Yes (percutaneous biopsy)
Nsg Duties prior: assess for bleeding risk; IV access; ensure pt has toileted;
NPO 4 hrs prior
Nsg Duties during: instruct pt to exhale and hold while needle inserted
Nsg Duties after: apply pressure dsg; instruct pt
Infection Risk
What it is:
"Risk of infection" is a frequent nursing diagnosis used to identify patients at
risk of acquiring a opportunistic, nosocomial, pathogenic, or communityrelated
pathogen.
Nursing Application:
Specific nosocomial infection risks are addressed by
Discharge Planning
What it is:
The process that facilitates the movement of patients between facilities or
from a facility to home/home care; the goal is enhance continuity of care; the
key to successful discharge planning is multidisciplinary communication.
Nursing Applica
Legislation
The Civil Rights Act of 1964: outlaws discrimination based on gender, race,
color, religion, or national origin; ended racial segregation in public facilities;
prevents discrimination by agencies that receive federal funds
� The Rehabilitation Act of 1973
Healthy People 2020 Initiatives
What it is:
10-year National health objectives designed to address the most significant
preventable health threats; plan includes 42 topic areas, with heavy emphasis
on heart disease and stroke prevention; find more info at healthypeople.gov.
Nursing Appl
Appendicitis
Possible Causes: bowel cancer, infection, barium ingestion, fecal mass
Notable symptoms: RLQ abd pain, fever, tachycardia, N/V, Rovsing's sign
Diagnostic Test(s): elevated WBCs, abd U/S, CT scan
Nursing Dx: Acute Pain, Risk for infection
Nursing Tx: Fowle
Cholecystitis
Possible Causes: gallstones, bacterial infection
Symptoms: sharp RUQ abd pain; referred pain to right shoulder, N/V, positive Murphy's sign
Dx Test(s): abd U/S, serum alk phos, lactate, AST/SGOT and bilirubin elevated
Nursing Dx: Acute Pain, Risk for infe
Liver Cirrhosis
Possible Causes: alcohol, hepatitis, toxins, gallbladder disease, hemochromatosis, right-sided heart failure
Notable symptoms: enlarged liver, N/V, diarrhea or constipation, flatulence, dull abd pain, weight loss
Diagnostic test(s): liver biopsy, liver fu