What is mandated?
- Health Insurance or Health Information Will be shared.
- Hilllary Clinton made it happen (GOVERNMENT).
DRG (Diagnostic Related Group)
They Determine stay of patient and the money they get for a certain illness.
- 12-20 Adult
- 30-60 Children
- Slower respiration- with older adult.
- Blood loss, dehydration, stress, age groups, illness, medication, etc.
- Can change with age differences.
- Older adults hardening of arteries.
- Higher Older/ Younger Lower.
- Hand grip, foot pushes up and down, Bilateral strength, document, deficits can be a falls risk, labs.
- Close to call button, person, walker, on strond side of body for a cane and we stand on the weak side when ambulating.
- Measure arterial O2 in the blood.
- ABG is more accurate for reading.
- Check O2 if looking blue or gray in color, make sure its on, and in the nose.
- Color, Turgor, Moisture, no break down on inspection, & temperature.
- Check Tedd hose no wrinkles. Check circulation in popliteal and dorsal pedal pulse, or posterior tibeal pulse.
- Topical Creams- Apply with gloves.
- Injections- 5 rights, 3 checks, supplys need and syringe with medication, air in vial with draw medication, clean skin alcohol, land mark on patient, dispose of needle and syringe in sharps.
- P.O.- Enteric coated medications cannot crush or chew. If coating is gone, possible overdose, stomach irritation, etc.
- Sublingual dissolve meds- Don't eat for a 1/2 hour.NG Tube- Aspirate check ph and residual, flush/ give /flush.
How to verify Orders or RX-
Look are Dr. Order and the MAR. Its the nurses responsibility to check, they are the 3rd check Person.
taken 1 hr. after the medication if given.
Drawn 1/2 hour before medication is given usually on 3rd dose.
- An extension or secondary effect of a drug.
- EXP. Hives, weeze, Palpitation, N/V, Constipation, rash, etc.
- Constipation- Push fluids, ambulate, increase fiber.
- Dirrhea- eat yogert with live cultures in it.
Meds that change urine color-
- Pyridum- Orange/red UTI.
- Anticoagulants- Red
- Beets-red or pink
- Levodopa-Black/Brown blood pressure
- Diuretics- pale yellow/Clear
- Inhalers, metered dose, or Nebulizer.
- Inhale through mouth.
- Increase B/P and Heart Rate only temporary with go away.
Medications for Cardiovascular Complications
- Ace Inhibitors
- Beta blockers- Antihypertensives
- Anticoagulants-Cumarin, Heprin, SCD, Tedd Hose, to prevent thrombis.
- Causes-Postop surgery, bedrest, not moving or amulating much.
Hct (male, female)
- male = 40-54%
- female = 38-47%
- Na135-145 mEq/L
- BUN10-20 mg/dL
- ABG: pH PaO2 PaCO2 HCO3 SaO2
- pH = 7.35-7.45
- PaO2 = 80-100 mmHg
- PaCO2 = 35-45 mmHg
- HCO3 = 22-26 mEq/L
- SaO2 = 94-100%
- PT11.0-12.5 seconds
- AST (=SGOT)0-35 u/L
- ALT (=SGPT)4-36 u/L
- Ammonia10-80 mg/dL
- Total Protein6.4-8.3 g/dL
- Bilirubin: Total? Indirect? Direct?
- Total = 0.3-1.0 mg/dL
- Indirect = 0.2-0.8 mg/dL
- Direct = 0.1-0.3 mg/dL
- Lithium0.6-1.2 mEq/L therapeutic
- Albumin3.5-5 g/dL
- Urinalysis: albumin pH WBC glucose
- albumin = 0-8 mg/dL
- pH = 4.6-8.0
- WBC = 0-4
- Glucose = negative
- LDL60-180 mg/dL
- HDL (men, women)
- men = 45-50 mg/dL
- women = 55-60 mg/dL
- Total Cholesterol122-200 mg/dL
- Magnesium1.3-2.1 mEq/L
- Good control = 2.5-5.9%
- Fair control = 6-8%
- Poor Control = >8%
- Bleeding Time1-9 minutes
- Digoxin0.5-2 ng/mL
- RBC (male, female)
- Male = 4.7-6.1 million/mm^3
- Female = 4.2-5.4 million/mm^3
- Hgb (male, female)
- male= 14-18 g/dL
- female = 12-16 g/dL
- Potassium3.5-5.0 mEq/L
- Glucose70-110 mg/dL
- ESR (male, female)
- male = 0-10 mm/hr
- female = 0-20 mm/hr
- aPTT (=PTT)20-36 seconds
- Creatinine (male, female)
- male = 0.6-1.3 mg/dL
- female = 0.5-1.0 mg/dL
3.5-5 year olds like bananas.
Tortilla wrap With avacado, banana, and spinach, or green leafy vegtables.
Tetiny if to much.
- 135-145 Weight of hot Girl LOL!
- Low sodium-Old people especially dehydration, dry mucus membranes, low out put, increased heart rate, skin turgor tents, decreased B/P, confusion, dry mouth, loss of thirst for water, etc.
- Document skin tents, or not, don't put with normal limits.
- Drawn by nurse, seen in COPD broad umbrella category.
- Change in PAO2.
- Patient determines pain.
- PCA- Patient controlled Analegesic device. Patient is only one who can push it.
Types of Pain-
- Nerve-Pain from Nerves. Like Cyatica.
- Chronic-Lasting longer than 6 months.
- Acute- Shorter than 6 months.
- Cutaneous- Pain from Skin, bones, organs(Visceral), etc.
- Phantom-pain for nonexistent part of body that has been removed or lost.
- Reffered pain- hurting in chest(heart) and it manifests in the arm.
Misconpetions About Pain Medications-
- Side effects, addiction, wait til pain is high, natural to have pain, Etc.
- Rate pain intensity of pain from patient 0-10.
Maslow's Hierachy of Human Needs
- Love and Belonging
- Colaborative Care-Patient, family, Dr., Nurse. Contunity of care, Pain meds given by dr. Orders.
- Nurse initiated care- a care plan of patient. Don't need dr. order to do these.
- EXP. give drink of water, bathroom, etc.
- Purpose of Documentation- document really well its to cover you if your sued, if its not documented it didn't happen.
- Deligation- Make sure that they can do it. Right task, right circumstance, right person, & right supervision.
Who Accredits a school of Nursing?
The State or State Board
Damages, Causation, Duty, Breach of Duty
- Damages- To cause harm or injury to a person.
- Causation- Anything that produces an effect, cause to effect, action of causing.Duty-Something that one is expected or required to do by moral or legal obligation.
- Breach of duty-Unexcused failure to fulfill one duty.
Nursing Theories 4 Concepts-
- Patient-Most important of all 4 concepts.
- Enviroment-Things that surround us, conditions, influences, and Milieu(atmosphere or environment).
- Health- General condition of the body and mind:good health of bad health.
- Nursing-A person educated and trained to care for the sick and afflected.
Focus of Nursing
Is on the Patient!
- Idea of mental image one has on themselves and one strengths, weaknesses, or status.
- Their self image.
The achievement of one's full potential through creativity, independence, sponiatety, and grasp of the real world.
- Strength, values, beliefs help them with self-esteem.
- Exp. Shower, shave, apply makeup, & etc.
Who influences children?
Culture, parents, and friends(peer pressure).
Recognition of whats Valuable-
- Ask ?'s, give them value that they are a person, care, talk, and listen.
- Ask routeins!
- Native American/ Hispanic
- Characteristics- Lack of eye contact, not being touched, called by right name, & etc.
- Foods- How its prepared, eaten, who eats with whom, and eat it with what.
Herbs can react with medications.
Ask how they would do it, if you don't know.
Don't sterotype, ethnocentrism, racism, prejudice, and discrimination.
Loss, Grief, Death
- Loss- Percieved, physical, Situational, anticipatory, actual, & Maturational loss-is experienced as a result of natual developmental process.
- Grief- Mental suffering of distress from afliction or loss, and is necessary to maintain emotional and physical well being.
- Death-The end of life, occurs when all vital organs and systems cease to function, no breathing, and no brain activity.
Kubler Ross 5 stages of Grief
Denial, anger, barganing, depression, and acceptance.
Is care aimed a symptoms rather that curative treatments. End of life care, comfort care.
Is an individual's response to the loss of a significant other.
- Shock and disbelief
- developing awareness
- resolving loss
Spirituality/ Limits in Health Care
- Jehovah witness- no blood, no holidays beliefs, etc.
- Lds- limits of not to health care.
- Prayer- If they need spritual support and they ask you.
- Intervention- Call someone from outside, ask staff, prayer, help with blessing if asked, etc.
Risk for infection R/T chronic disease, altered skin integrity, effects of medication, malnutrition, lake of immunizations, and indwelling medical device.
- Hospital acquired infection.
- Due to lazyness, not following protocol, not washing hands, etc.
- Is smallest microorganisms. Causes common cold, and many other diseases like, AIDS, herpes, etc. Antibotics don't effect them, need antivirals to effect and kill.
- Raised white blood cells with infection, immune system fights them off.
not intentional infection you just get it, catheter, IV, surgery, from a medical precedure.
Body Defense- Immune System-
- 1st- Normal body Flora.
- 2nd-Inflamatory Response
- 3rd- Immune response
An infection involving microorganism that invaded the bidy at a specific site and remain there until they are eliminated.
An infection in which the pathogen is distrubuted through out the whole body, rather than one spefic spot.
- Pain relief, improved blood circulation, comfort, speeds inflamitory responce, and etc.
- Rational for healing- heat speeds healing.
- Time Frame-20 minutes on, 40 off, check with in 10 minutes of applying.
Pressure Ulcer Staging- 1-4
- 1-Tomato, red non-blanching.
- 2-Potato, epidermis is gone, shallow crater, partial thickness.
- 3-Apple, epidermis and dermis are gone, big crater, partial to full thickness.
- 4-Peach, full thickness, bone/muscle/ tendon/adipose tissue are showing.
- Post Menopause- Absense of menstrual cycle, falling estrogen levels, leads to weaken bones, osteoprosis, hair loss, facial hair, and vaginal dryness.
- Cercival cancer- HPV, STD, more that 1 sex partner, impared immune system, and birth control pills taken over 5 years.
- Masterbation- discuss if brought up by patient.
Gas- General Adaptation syndrome-
- Alarm, resistance, exhaustion.
- It is the bodys general response to stress.
- Alarm-Race fight or flight.
- Restistance- Mobilize resources and adapt to stressor.
- Exhaustion- All adaptive mechanisms are exhausted.
Sympethetic nervous system increases, digestion decreases, hormone level increases, Which increases HR, B/P, and increased respirations.
- Explain procedure to decrease anxiety.
- Teach about what to expect- dry mouth, medications dry them up, can have sore throat, deep breath, etc.
Follow up on medications, don't drive, follow up care, don't sign legal documents, and demonstrate selfcare.
Aging Adult- Erickson's
- Life review or reminisent, the wholeness perspective.
- Middle adult- like to feel useful and benificial to society, or be worthless.
elderly care for a week or short time so family or care provider can have a break.
Hearing loss prevention-
Wear ear protection, lower volume on tv music, blow your nose gently can cause damage to ears, avoid noisy situations, etc.
Non-Pharmacological interventions to promote Relaxation
- Music and Relaxation
- theraputic touch
- hot and cold application
- cutaneous stimulation
Ways to facilitate sleep-
Music, relaxitation, darkness, little or no noise, don't work out before bedtime, etc.
- Loss of vision and hearing.
- Reduction of environmental stimuli by physical isolation and loss of eye sight.
Most common- Insomnea, Sonombulism, narcolepsy, sleep apnea, hypersomnia, restless leg syndrome, and sleep deprivation.
Nutritional lab used to determine nutritional status?
Pyramid Food Guide
- Grains 6 oz daily
- Vegtables 2 1/2 cups daily.
- Fruits 2 cups daily.
- Milk 3 cups daily.
- Meat and beans 5 1/2 oz daily.
- Moderate physical activity daily.
- Fluids (water).
Closed ended ?'s or statements-
- Leaves persons with limited choices that re answered in one or two words, like yes or no.
- Non-Verbal ways to Communicate- Body language, gate, touch, appearence, eye contact, gestures, and facial expressions.