Introduction Comprehensive Review Nursing process Quality improvement Reports

Introduction Comprehensive Review

Nursing process Quality improvement Reports Resources Delegation Roles of nurses

Process Continuity of Care • Focus on the experience of the client. Does the care of the patient flow from care giver to care giver Quality • A philosophy that doing the right thing, the right way, the first time with problem solving that leads to quality outcome • Performance improvement groups are formed to improve standards of care for hospitals

What if ………… Variance • Variance or incident –an event that occurs outside of the usual expected normal events. Not intended to point blame just document facts. It confidential and should not be documented in the medical record. What is an incident? • Client injury • Malfunctioning equipment • Unanticipated adverse reaction • Unethical illegal or incompetent practice • Toxic spills, fire • Violent behavior • Loss or property

Resources and consultation. . Case Mangement • Is a collaborative process of assessment and planning • Advocacy for services for the client • Nursing role is to identify when case management would be helpful Consultation/Referral • Provides expert advice or a formal request for a special service by another caregiver • Nursing role scheduling; calling and giving report

Delegation and Prioritization • Delegation –transferring the authority to perform a selected task while maintain the responsibility-CAN • Assigning – transferring the authority and accountability and responsibility to another member RN-assigning med pass to LPN • Supervising monitoring the progress toward completion of delegated task – ultimate responsibility for the outcomes

Continued……………. Rights of delegation Delegate or NOT • Right person • Right task • Right circumstances • Right direction and communication • Right supervision and elevaluaiton • Process • Education • Task • Think TEA • Activity time ……………. .

Which of the following can be delegated? Shave a client Transfer a client from the bed to the chair Perform tracheostomy care Perform oral suctioning Assist a client who has visual impairment with meals Reposition a client Insert an indwelling cath Feed a client via NG tube Monitor IV Collect a clean-catch urine Record input and output Monitor response to medication Remove antiemboism stockings

Which of the following can be delegated? Shave a client- AP Transfer a client from the bed to the chair-ap Perform tracheostomy care-lpn Perform oral suctioning-lpn Assist a client who has visual impairment with meals-ap Reposition a client-ap Insert an indwelling cath-lpn Feed a client via NG tube=lpn Monitor IV-lpn Collect a clean-catch urine-lpn Record input and output-ap Monitor response to medication-lpn Remove antiemboism stockings –ap

Prioritization life before limb Acute before chronic Actual problems before a potential problem Maslow’s Hierarchy of needs PHYSI before Py. SCh Trends before transient Emergencies vs complications What procedure should come first –pain med before scheduled med; cath urine before bath

Activity Time • Group A • 1234 • Group B • 1234 • Group C • 1234

Terms • Autonomy • Beneficence • Confidentiality • Fidelity • Justice • Nonmaleficence • Paternalism • veracity

Advance directive Living willspecific plan the client has made Durable power of attorney –legal document that designates another person to make health care decisions DNR- ? What does it include or exclude ?

Legal matters • Felony • Misdemeanor • Tort • Good Samaritan Law • Impaired co-worker • Malpractice • Negligence

Role of the Nurse in an emergency disaster • Emergent or class I red tag- no delay in care • Urgent or Class II yellow tag 1 -2 hour • Nonurgent or Class III Green- 2 -4 Expectant or class IV black- expected to die Activity time …………. .

Which triage level would you give? Number your board 1 -12

FALLS Older Impaired mobility Cognitive or sensory impaired Bowel bladder dysfunction Side effects of medication History of falls Yellow arm band; mats non skid socks and leaf on the door? Say what Review nursing interventions…

Restraints Include human, mechanical, chemical or physical devices that restrict freedom of movement or diminishes access to parts of the body. Nursing Interventions include>>>>>>>>

13 steps to seizure care included………….

Seizure care

Fire Safety

Positioning a patient Semi-fowlers. Fowlers High fowlers Supine Prone Lateral Sims Semi-prone lithotomy Trendelenburg Modified Trendelenburg Reverse Trendelenburg elevation of limb Dorsal recumbent

Crutch walking and other ambulation devices • Basics: fit =2 -3 finger widths between axilla and top of the crutches • Weight bearing is on the palms not the axilla place crutch tip six inches from feet

Continued ……………. • Non-weight bearing • Begin in tripod position, maintain weight on the unaffected side • Advance both crutches and the affected side • Move the unaffected weightbearing foot forward beyond crutches • Continue sequence • Weight bearing • Move crutches forward about one step • Move affected leg forward level with crutch tip • Move the unaffected leg forward • Continue

Walking up stairs • 1. hold onto rail with one hand crutches with the other hand • 2. Push down on the stair rail and the crutches and step up with the unaffected leg • 3. If not allowed to place weight on the affected leg hop up with the unaffected leg • 4. bring the affected leg and the crutches up bedside the unaffected leg • 5. Remember the unaffected leg goes up first that eh crutches move with the affected leg

Walking Down stairs • 1. place the affected leg and the crutches down on the step below; Support with by leaning on the crutches and the stair rail • 2 BRING the unaffected leg down • 3 Remember the affected leg goes down first that and the crutches move with the affected leg

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