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NURS246 FINAL EXAM
Statutory Law criminal law (prevents harm to society) -felony: lengthy time in jail in federal or state facility -misdemeanor: punishable by fine or stent in county jail -civil law: fine, civil dispute regulatory law created by regulatory bodies, FDA, OSHA, State Board of Nursing Common law passed down through the court system, not written (ability of patient to refuse care -state level: nurse practice act -federal level: Americans with disabilities act Standards of Care legal guidelines for nursing practice, provide minimal acceptable nursing care -set by each state in its Nurse Practice Act, federal and state laws, by professional nursing organizations, HC facilities, and accrediting bodies -MUST know your state's standards of care and restrictions -KNOW policies and procedures of your organization Torts civil wrong against person or property, non-criminal
-does not include jailtime and is usually remedied by a fine -intentional and unintentional Intentional torts assault, battery, false imprisonment, invasion of privacy, defamation of character assault threat or attempt to injure -patient refusal, but continue anyways -threat battery unlawful touching of another person without consent -intention not touching without consent -act false imprisonment restraining an individual or restricting an individual's freedom -unjustified restraint of a person against their wishes invasion of privacy violating a person's right not to have his or her name, photo, or private affairs exposed or made public without giving consent
malpractice Failure by a health professional to meet accepted standards -professional negligence, must prove to the plaintiff What must the plaintiff prove for professional negligence (malpractice)?
- Nurse owed duty to injured patient
- Nurse failed their duty
- Patient suffered harm or damages
- Nurses breach of duty caused patients injuries, legal causation Common forms of nursing malpractice
- Failure to note a change in patient condition; poor documentation, must also inform others
- Misuse of medical device: ensure you are informed with the devices you are using
- Failure to get informed patient consent: ensure patient is ok with receiving care and can withdrawal at any time
- Documentation error: BP 98/62 documented as 28/
- Failure to promptly carry out doctor's order: read doctors orders, consistently check orders
- Failure to assess and document patient's condition or complaint: MUST document any changes and assess for these changes regularly (doubt=ask)
- Failure to notify doctor of a patient's condition: must notify the doctor for any change, if complaining about anything new assess, document, and report
- Failure to evaluate and respond to a patient's needs: any new issue must be assessed, any patient need must be accounted for
- Medication error: verify meds, ask why pt receives meds, how are meds supposed to work, what are potential side affects, how do we administer safely, what do we need to do, what do we monitor
Professional conduct/boundaries -High degree of patient vulnerability and prolonged patient contact are two situations in which violations of professional boundaries tend to occur -behaviors indicating potential violation: engaging in excessive self-disclosure of personal info, keeping secrets w/ a pt., spending excessive amounts of time w/ one pt., acting as if pt. is a close friend, failing to protect the pt. from inappropriate sexual involvement w/ nurse Documentation nurses must document patient information in written or electronic format -this information becomes the legal record of the patient care that was provided -documentation must be objective, accurate, and timely -can alter trajectory of pt. care if documentation in incorrect, NEVER copy and paste previous documentation always use your own Nursing Students -can't witness any legal document -can't administer blood, can watch but NEVER be apart of the administration -CAN be held liable for their actions -only act in role of nursing student, no matter outside experience (PCT) Health Insurance Portability and Accountability ACT (HIPAA) federal statutory act to protect privacy, confidentiality, and security of medical information -always ask if it is okay with the patient to perform medical acts in front of others within the room -privacy and confidentiality -control access to medical records (safety risk is only exception)
-basic needs met -body system integrity -lifestyle choices -age/age related changes Factors affecting adult safety -Stress (work, financial, relationship) -Substance abuse (illicit or prescription, alcohol, MVA) -Tobacco/ E-cigarettes -Sex/STDs -Workplace hazards Safety in the Health Care Setting Monitor falls, medication administration, healthcare-associated infection (HAIs)/ multi-drugs resistant organisms (MDROs), and procedurall errors Chemical Safety -understand proper use of personal protective equipment (PPE, Donning and Doffing) -monitor/limit/prevent inhalation, contact (skin and eyes), ingestion or indirect contact, and injection (needlestick injury) Radiation Safety -risk directly r/t length of exposure time and distance from radiation source -diagnostic studies -excessive exposure -> cellular damage to skin, GI tract, reproductive organs
-wear proper PPE when handling urine/blood for certain patient populations -You do not always see the risk from radiology exposure right away, takes a while to show the issues -abide by the risk to benefit ration Electrical safety always assess equipment/devices working properly (prevents electrical fires, electrical shock -remove/report faulty equipment, rag for maintenance -always look for hazards R.A.C.E healthcare fire safety -Rescue anyone in immediate danger of the fire -Alarm, activate the nearest fire alarm and call your fire response telephone number -Contain fire by closing all doors in the fire area -Extinguish small fires, if the fire cannot be extinguished leave the area and close the door Fire Extinguisher (P.A.S.S.) -Pull the pin, release a lock latch of press a puncture level -Aim the extinguisher at the base of the fire -Squeeze the handle of the fire extinguisher -Sweep from side to side at the base of the flame Restraints
Alternatives to restraints
- move patient close to nurses station
- use pressure sensitive bed and chair alarms
- encourage family members to stay/obtain order for a 24-hour sitter
- minimize environmental stimuli
- provide distraction (tv, music, gentle back rubs)
- assess for basic needs
- cover IV sites/tubes/drains with gauze
- place untied protective mittens on the patients hands Psychological safety the perception and confidence that all members of a team will be valued for their contribution, without ridicule or embarrassment -basic assumption: we believe everyone is intelligent, capable, care about their best, and wants to improve -focus on mutual goals for learning and commitment to excellence Stage 1: Psychological safety Inclusion safety: satisfies the basic human need to connect and belong. You feel safe to be yourself and are accepted for who you are, including your unique attributed and defining characteristics Stage 2: Psychological safety
Learner safety: satisfies the basic human need to learn and grow. You feel safe to engage in the learning process - asking question, giving and receiving feedback, experimenting, and even making mistakes Stage 3: Psychological Safety Contributor safety: satisfies the basic human need to make a difference. You feel safe to use your skills and abilities to make a meaningful connection Stage 4: Psychological Safety challenger safety: satisfies the basic human need to make things better. You feel safe to speak up and challenge the status quo when you think there's an opportunity to change or improve Horizontal violence acts of unwanted abuse or hostility in the workplace, where bullying is described as repeated acts of aggression over time
50% of incidents never reported; 80% of nurses have experienced some form; high % have witnessed it -risk for physical and psychological harm -increases risk for medical errors, decreases job satisfaction/staff morale, self-esteem of nurses, and the retention of staff What are the goals of exercise and activity? proper balance, posture, & body alignment -reduce risk of injury -maintain level of independence (mobility and ADLs)
Respiratory consequences of bed rest Atelectasis (alveoli collapse), hypostatic pneumonia, and activity intolerance (SOB, DOE, Fatigue) Urinary consequences of bed rest renal stasis and renal calculi Gastrointestinal consequences of bed rest hypomotility -> constipation and impaction Integumentary consequences of bed rest skin breakdown relating to decubitus ulcers Psychological consequences of bed rest sensory deprivation and altered sleep patterns Assessment alignment/posture - center of gravity -ROM: inflammation, contractures, swelling, pain -Gait: rhythm, cadence, speed, need for assistance -Exercise regimen: how often, level of conditioning, activity intolerance
Assessment procedures -measure muscle atrophy: anthropometric measurements (ht, wt, skin fold thickness), muscle strength and tone -lab work: electrolytes, serum protein (albumin), blood urea nitrogen (BUN) -food intake (calories and protein) -respiratory: RR, depth if inspiration, effective airway clearance -CV: BP, apical & peripheral pulses, venous stasis (signs of DVT) -fall risk -BMAT -activity intolerance -skin assessment Bedside Motility Assessment Tool (BMAT)
- Sit and Shake
- Stretch and Point
- Stand
- Walk Nursing Diagnoses -Activity intolerance -Impaired physical mobility -Risk for falls -Alteration in tissue perfusion -Impaired gas exchange -r/t prolonged bedrest or prolonged inactivity
-fall risk interventions Cardio interventions orthostatic hypotension: early ambulation, dangling at side of bed, isometric exercises (do not move joint, resistance), and change positions slowly Peripheral vascular interventions DVT: SCDs (sequential compression device), ROM/position changes, fluids, heparin, TEDs (thromboembolic device) compression stockings, foot circles (ankle pumps) pulmonary interventions -Turn cough deep breath -elevate HOB -incentive spirometer -percussion -hydration Nutritional Interventions -hydration -high protein diet/calories/supplementation -TPN (total parenteral nutrition) -enteric tube feedings Elimination interventions
-hydration (2000-3000ml) -check bladder distention -increase fiber and stool softeners to prevent constipation -early ambulation Skin interventions -identify high risk patients (Braden Scale) -position changes (turning schedule, hourly rounding) -skin care -heel/elbow protectors -float heels Psychosocial interventions -informal socialization -schedule activities to enhance sleep -provide stimulation/orientation -caring behaviors -calendar on wall Patient positioning goals
- maintain functioning of muscles
- prevent deformities
- prevent complication of skin breakdown
- prevent pneumonia
Sim's Position similar to side lying except dependent shoulder is behind the patient, recue position -drainage of oral secretion and maintenance of airways -use pillows to support alignment of upper arm and knee/hip Prone position Lying on stomach -use pillow, trochanter rolls, and hand rolls to maintain musculoskeletal functioning -maintain head position to protect the airway -used for patients with spinal surgery & respiratory illness (COVID) Supine Position lying on back, facing upward -preferred position -ease of assessment -most susceptible for pressure ulcers on coccyx and sacrum Trendelenburg position lying on back with body tilted so that the head is lower than the feet -used for shock (facilitates venous return), postural drainage -used to aide in moving a bariatric patient up in the bed Reverse Trendelenburg position supine with head higher than the foot, FOB lowered
-good for gastric emptying and prevents esophageal reflux Active ROM Is movement initiated and completed by the patient without assistance. Passive ROM Movements that are performed by the examiner with the patient unable to move independently Active-Assistive ROM Performed by the client with assist by RN Increases motion in joint Performing ROM
- place one hand close to the joint being moved
- place one hand close to the next closest joint without going past it
- Provide support with palm of hand in cupped position Trapeze bar allows the client to pull with the upper extremities to raise the trunk off the bed, assist in transfer, or to perform exercises Lift Sheet (Draw Sheet)
