1. NURSING PROCESS
2. PT EDUCATION
3. TASKS THAT REQUIRE RN JUDGEMENT
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LPNS
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-Scope of practice determined by RN practice acts, which vary state to state
-Monitor pt findings (as input by RN)
-Reinforcement of pt teaching from a standard care plan
-Contributes to care plan
-Adminsteres IVPB meds
-Monitors IV fluids
-Trach care
-Suctioning
-Checking NG tube patency
-Admin of enteral feedings
-Insertion of urinary catheter
-Med admin (excluding IV meds in many states)
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AP
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-ADLS: Grooming, bathing, dressing, toileting, ambulating, feeding (without swallowing precautions!!!), positioning, bed making
-Specimen collection
-I&O
-VS on STABLE pts
-Assemble pt med records
-Maintain safe env
-Recognize situations to report to immediate superior
-CAN NOT DO DRESSING CHANGES
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NURSE STAGES
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1. NOVICE=Student or new grad
2. ADVANCED BEGINNER=Most New RNs
3. COMPETENT=2-3 yrs experience
4. PROFICIENT=Signif amt of experience; holistic care
5. EXPERT=Do not need to rely on rules
1. LIFE BEFORE LIMB
EX: Shock over pt w limb inj
2. ACUTE BEFORE CHRONIC
3. ACTUAL BEFORE POTENTIAL
4. MASLOWS: SELSP
5. EMERGENCIES VS. EXPECTED FINDINGS
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BUDGETS
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PERSONAL=Worked time and benefit time
OPERATING=Electricity, maintenance, and supplies
CAPITAL BUDGET=Buildings or major equipt
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ETHICAL PRINCIPLES
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VIDELITY=Be faithful; keep promises
NONMALEFICIENCE=Not to do hard
VERACITY=Tell the truth
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ANA CODE OF ETHICS
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-Sets guidelines to use when providing pt care
-Outlines RN resp to pt and profession of nursing
-Assists the RN in making ethical decisions
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ORGAN DONATION
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-Regualted by state and fed laws
-RN must present option of organ donation to all fams
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ADVANCE DIRECTIVE
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=Doc in which pt who is competent is able to express wished re: future acceptable health care (including the desire for extraordinary lifesaving measures: CPR, intubation, and artificial hydration or nut)
-Able to designate another person to make dec when the pt becomes physically or mentally unable to do so
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LIVING WILL
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=Legal doc that instructs health care providers and fam members about what, if any, life-sustaining tx an individual wants if at some time the ind is unable to make dec
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DURABLE POA
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=Legal doc that desgnates another person to make health care dec for pt when pt becomes unable to make dec independently
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INFORMED CONSENT
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-RN must witness signature
-CAN provide clarification to info already given by MD
-CANNOT provide NEW info
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TYPES OF LAWS AND COURTS
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1. CRIMINAL LAW
-Felony-Major
-Misdemenaor-Minor
2. CIVIL LAWS
TORT LAW:
1. UNINTENTIONAL TORTL=Negligence, malplactice
2. QUASI-INTENTAIONAL=Breach of confidentiality, defamation of char
3. INTENTIONAL TORT=Assault (threat), battery (touch), false imprisonment
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CONT'D
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3. STATE LAWS=Nursing pracitce reg by state law. Each board of RN ahs rules reg and stand that vary
FEDERAL REGS=Hippa, ADA, etc.
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MALPRACTICE
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=Failure to act in reasonable and prudent manner
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NEGLIGENCE
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=Omission to do something that a reasonable person would do OR
=Doing something that a resonable person would NOT do
-Standard of pro practice is developed by prof. organizations
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ASSIGNING
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=Process of transferring auth, accountability, and resp of pt care to another member of the health care tea
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DELEGATING
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=Process of tranferring auth and resp to another team member to complete a task while retaining accountability
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SUPERVISING
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=Process of directing, monitoring, and evaluating the performance of tasks by another team member of the health care team
-RNs resp for supervision of pt care tasks delegated to AP adn LPNS also knowsn as UAP and LVN
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5 RIGHTS OF DELEGATION
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1. TASK=What task should be delegated
2. CIRCUMSTANCE=Under what circumstances
3. PERSON=To whom
4. DIRECTION/COMMUNICATOIN=What info should be communicated
5. RIGHT SUPERVISOIN/EVAL=How to supervise/evaluate`
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AVODIING/WITHDRAWGIN
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-Both parties knowthres conflict but refuse to face it or fix
-May be approp for minor confl when 1 part holds more power than other of is issue may worl itself out over time
-BC conflict remains, it may surface again at later data and escalate over time
-Usually LOSE LOSE sit
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SMOOTHING
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-1 party attempts to smooth another party by trying to satisfy the other party
-Often used to preserve or maintain a peaceful work env
-This focus may be on what is agreed upon, leaving conflict largely unresvoled
-LOSE LOSE sit
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COMPETING/COERCING
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-1 party pursues a desired solution at the expense of others
-Managers may use this when a quick or unpopular dec must be made
-Party who loses something may experince anger, aggrevation, and desire for retibution
-WIN-LOSE sit
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COOPERATING/ACCOMADATING
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-1 party sacrifices something, allowing the other party to get what it wants
-Opposite of competing
-Original prob may not actually be resolved
-Solution may contribute to future conflict
-LOSE-WIN sit
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COMPROMISING/NEGOTIATING
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-Each party gives something up
-To consider this a WIN/LOSE WIN/LOSe sit, both parties must give up something equally imp
-If 1 party give up more than the other, it can become a WIN-LOSE sit
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ORDER OF GENERATIONS
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1. VETERAN 1925-1942
2. BABY BOOMER 1943-1960
3. GENERATION X 1961-1980
4. GENERATION Y 1981-2000
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DEC MAKING
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DECISIVE=Min, one option
FLEXIBLE=Limited, several option
HIERARCHIAL=Large, one option
INTEGRATIVE=Large, several option
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TEAM
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1. FORMING=Get to know; ledaer defines tasks for team and offers directoin
2. STORMING=Conflict arises, and team mem begin to express polarized viewe
-Team est rules, and members begin to take on various roles
3. NORMING=Team est rule; members show respect for on eanother and begin to accomplish some of tasks
4. PERFORMING=Team focuses on accomplishmen tof task
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INTENTIONAL TORTS
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1. ASSAULT=Makes another person fearful and aprpehensive; threatening to place NG tube in pt refusing to eat
2. BATTERY=Intentional and wrongful physical contact w person that involves injury or offensive contact (restraining pt and giving injection against his wishes)
3. FALSE IMPRISON=Use restraints in pt to prevent him from leaving
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TRIAGE
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1. EMERGENCY=CLASS 1=Highest priority!!!! Who have life threat inj but high poss of survival once stable
2. URGEN=CLASS II=Second hightest-to pt who have minor inj that are not yet life threatening and usually can wait 45-60 min for tx
3. NONURGENT=CLASS III=To pt who have minor inj and not life threat and do NOT need immed attn
4. EXPECTANT=CLASS IV=LOWEST priority-given to those NOT EXPECTED TO LIVE and allowed to DIE NATURALLy-Comfort measures will be given but restorative measures will not
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