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Nurse

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A person who nourishes, fosters, and protects and who is prepared to take care of sick, injured, and aged people

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Aims of Nursing

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To promote health To prevent illness To restore health To facilitate coping with disability or death

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Four essential competencies

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Cognitive, Technical, Interpersonal, Ethical/legal skills

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Nursing Practice Acts

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laws established in each state in the US to regulate the practice of nursing

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Reciprocity

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allows a nurse to apply for and be endorsed as a registered nurse by another state

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Nurse Licensure Compact

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allowing a nurse who is licensed and permanently lives in one of the member states to practice in the other member states without additional licensure.

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Nursing Process

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major guideline for nursing practice, integrates both the art and the science of nursing

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Nursing Process

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Assess the patient to determine the need for nursing care, Determine nursing diagnoses for actual and potential health problems, Plan and Identify expected outcomes and plan care, Implement the care, Evaluate the results

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Infection Cycle:

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1. Infectious agent (bacteria, viruses and fungi) 2. Reservoir (natural habitat of the organism) 3.Portal of exit (point of escape for the organism from the reservoir) 4. Means of transmission (vectors or contaminated inanimate objects) 5. Portals of entry (where organisms enter a new host) 6. Susceptible Host (the degree of resistance the potential host has to the pathogen)

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Virulence

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its ability to cause disease

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endemic

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occurs with predictability in one specific region or population

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Stages of infection

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Incubation Prodromal Stage Full Stage of illness Convalescent Period

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Which is the most infectious stage of illness?

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Prodromal stage

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Inflammatory response

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protective mechanism that eliminates the invading pathogen and allows for tissue repair to occur. Also occurs in response to injury. Signs of inflammation are redness, heat, swelling, pain, and loss of function.

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Immune response

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involves specific body responses to an invading foreign protien or body's own protein. Antigen is the foreign material and the body fights it with anti-bodies.

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Humoral immunity

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the antigen-antibody response

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Factors affecting risk of infection

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integrity of skin and mucous membranes, pH levels, white blood cells, age, sex, race, heredity, immunizations, fatigue, stress level, and use of invasive or indwelling medical devices.

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Asepsis

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all activities to prevent infection or break the chain of infection

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Medical asepsis

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aka clean technique, involves procedures and practices that reduce the number and transfer of pathogens (hand washing or wearing gloves)

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HAI

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healthcare-associated infection

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nosocomial

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something orgininating or taking place in the hospital

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exogenous

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when the causative organism is acquired from other people

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endogenous

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when the causative organism comes from microbial life harbored in the person

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iatrogenic

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when it results from a treatment or diagnostic procedure

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disinfection

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destroys all pathogenic organisms except spores

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sterilization

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destroys all microorganisms including spores

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Standard precautions

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precautions used in the care of all hospitalized individuals regardless of their diagnosis or possible infection status

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Transmission-based precautions

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in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes

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Airborne

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Tuberculosis, varicella (chicken pox), rubeola (measles), and possibly SARS. Wear mask or respirator when entering room, may wear gown if necessary

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Droplet

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Rubella, mumps, influenza, meningitis, pertussis, diphtheria, and the adenovirus infection. Wear PPE upon entry into the room for all interactions that may involve contact with the patient within 3 feet.

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Contact

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Multi-drug resistant organisms (MRSA, VRE, VRSA, C.DIFF) wear PPE whenever you enter the room for all interactiosn that may involve contact with patient and patient's environment

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SBAR (S)

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Situation (patient name, location, code status, problem, assessment, vital signs, concerns)

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SBAR (B)

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Background (mental status, skin, oxygen needs)

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SBAR (A)

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Assessment (what you think the problem is, is it getting worse/better, address need for implementation)

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SBAR (R)

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Recommendations (what needs to be done, tests, change in treatments

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helping relationship

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exists among people who provide and receive assistance in meeting human needs

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documentation

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the written or typed legal record of all pertinent interactions with the patient

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patient record

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compilation of patient's health information

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documentation guidelines

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content, timing, format, accountability, confidentiality

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Health Insurance Portability and Accountability Act (HIPAA)

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guidelines on how to protect patient privacy

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According to HIPAA patients have the right to:

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-see and copy their health record -update health record -get a list of the disclosures a healthcare institution has made independent of discolosures made for the purposes of treatment, payment, and healthcare operations -request a restriction on certain uses or disclosures -choose how to receive health information

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source oriented record

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each healthcare group keeps data on its own separate form

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problem-oriented medical record

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organized around a patient's problems rather than around sources of information, all healthcare professionals record information on the same forms

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SOAP format

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Subjective data, Objective data, Assessment, Plan, is used to organize data entries in the progress notes of a POMR

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PIE charting

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does not develop a separate plan of care, the plan of care is incorporated into the progress notes in which problems are identified by number. Problem, Intervention, Evaluation. It promotes continuity of care and saves time because there are no separate plans of care.

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focus charting

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instead of a problem list or list of nursing or medical diagnoses, a focus column is used that incorporates many aspects of a patient and patient care. DAR format, Data, Action, Response.

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Charting by exception

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shorthand documentation method that makes use of well-defined standards of practice; only significant findings or "exceptions" to these standards are documented in narrative notes

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variance charting

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unexpected event, cause of the event, actions taken in response to the event, and discharge planning.

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Restraints

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physical devices used to limit a patient's movement, side rails, geriatric chairs with attached trays, and appliances tied at the wrist, ankle, or waist are physical restraints

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chemical restraints

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drugs that are used to control behavior and are not included in the person's normal medical regimen

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sentinel event

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an unexpected occurrence involving death or serious physical or psychological injury, or the risk of death or injury.

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foot drop

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foot is unable to maintin itself in the perpendicular position, heel-toe gait is impossible and the patient experiences extreme dificulty in walking

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Fowlers position

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semi sitting position, calls for head of bed to be elevated 45 to 60 degrees

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High Fowlers

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bed is elevated 90 degrees

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Low or semi-Fowlers

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bed is elevated only 30 degrees

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Supine position

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patient lies flat on the back with head and shoulders slightly elevated with a pillow unless contraindicated

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Side-lying or lateral position

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patient lies on side and the main weight of the body is borne by the lateral aspect of the lower scapula and the lateral aspect of the lower ilium

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Prone position

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person lies on the abdomen with the head turned to the side

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What does it mean to be professional?

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Must be accountable and responsible for your actions

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What is Goal 1 of the NPSG

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Improve accuracy of patient identification, at least two ways to identify patients

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What is Goal 2 of the NPSG

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Improve communication among caregivers (SBAR)

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What is Goal 3 of the NPSG

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Improve the safety of using medications

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What is Goal 7 of the NPSG

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Reduce the risk of health care associated infections

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What is Goal 9 of the NPSG

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Reduce the risk of patient harm resulting from falls

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What is Goal 14 of the NPSG

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Prevent health care associated pressure ulcers

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What is Goal 15 of the NPSG

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Identify safety risks inherent in its patient population (suicide)

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P in Person

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Psychosocial needs

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E in Person

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Elimination needs

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R in Person

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Rest, Regulatory, Reproductive needs

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S in Person

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Safety needs

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O in Person

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Oxygenation needs

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N in Person

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Nutrition needs

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QSEN

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Quality and Safety Education in Nursing, the goal is to address the challenge of preparing future nurses with the knowledge skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems in which they work

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Neutropenic

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Used with patients who are immunocompromised such as Chemotherapy, AIDS, or Organ transplants

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Meningitis is what kind of precaution?

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Droplet

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Measles is what kind of precaution?

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Airborne

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Chicken pox are what kind of precaution?

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Airborne

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Rubella is what kind of precaution?

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Droplet

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VRE is what kind of precaution?

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Contact

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What are the four main purposes of documentation?

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1. For communication with health care team 2. Used for reimbursement 3. Establishes a legal record 4. Used to provide data for research

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T or F, passive exercises provide for joint mobility and muscle tone

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FALSE, only for joint mobility

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What defenses does the body have against infection?

answer

Body's normal flora, inflammatory response and immune response

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