Week 9 Discussion: Fundamentals of Nursing Define the following ethical terms:
Autonomy – ability or tendency to function independently. Beneficence – doing good or actively promoting doing good; one of the four principles of the ethical theory of deontology. Nonmaleficence – fundamental ethical agreement to do no harm. Closely related to ethical standard of beneficence. Justice – ethical standard of fairness. Fidelity – agreement to keep a promise. Veracity – ethical principle that obligates you to tell the truth.
What is an advanced directive? It is a legal document that details preferences for health care, including care at the end of life. What are the two types of advanced directives? How do they differ?
Living Wills – represent written documents that direct treatment in accordance w/a patient’s wishes in the event of a terminal illness or condition. Health Care Proxies or Durable Power of Attorney for Health Care (DPAHC) – legal document that designates a person or persons of one’s choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf. NOTE on the Difference: The Living Will is actually a written document that the patient dictates in regards to specific medical treatments or no medical treatment wishes. The DPAHC is a document that the patient basically signs over the rights for someone else to make decisions on his/her behalf in the event that he/she is unable to do so. Specific medical treatment wishes are not actually spelled out in this type of document as they are in the Living Will.
What ethical principle is demonstrated by the use of advanced directives? The ethical doctrine of autonomy ensures the patient the right to refuse medical treatment. What is the difference between race and ethnicity? Ethnicity refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Ethnicity is different from race, which is limited to the common biological attributes shared by a group such as skin color. What are Erikson's eight stages of life?
Trust vs. Mistrust (Birth to 1 year) Autonomy vs. Sense of Shame and Doubt (1 to 3 years) Initiative vs. Guilt (3 to 6 years) Page 1 of 6
Week 9 Discussion: Fundamentals of Nursing
Industry vs. Inferiority (6 to 11 years) Identity vs. Role Confusion (Puberty) Intimacy vs. Isolation (Young Adult) Generativity vs. Self-Absorption and Stagnation (Middle Age) Integrity vs. Despair (Old Age)
Summarize Piaget's theory of cognitive development. It includes four periods that are related to age and demonstrate specific categories of knowing and understanding.
Period I: Sensorimotor (Birth to 2 years) – Infants develop a schema or action pattern for dealing w/the environment. Period II: Preoperational (2 to 7 years) – During this time children learn to think w/the use of symbols and mental images. Period III: Concrete Operations (7 to 11 years) – Children now are able to perform mental operations. Period IV: Formal Operations (11 years to Adulthood) – The transition from concrete to formal operational thinking occurs in stages during which there is a prevalence of egocentric thought.
What is the oxygenation device that delivers the highest concentration of O2? A nonrebreather mask w/reservoir bag. Minimum flow of 10L/min and delivers FIO2 of 60% to 80%. Which one delivers the most precise amount of O2? A Venturi Mask controls amount of specified oxygen concentration; delivers percentage of FIO2 from 24% to 60%. What liter(s) of O2 does a simple mask need to be set? Should be set @ 5 L or more to avoid rebreathing exhaled carbon dioxide retained in the mask. Which oxygen delivery method is considered low-flow? Nasal Cannula Explain the pathophysiology of why a patient with COPD should not receive high-flow O2? Patient’s w/COPD who are breathing spontaneously should never receive high levels of oxygen therapy because it results in a decreased stimulus to breathe. Do not administer oxygen @ more than 2 L/min unless a health care provider’s order is obtained. Hypoxia stimulates the drive to breathe in the chronic CO2 retainer patient. When applying O2, close monitoring is imperative to Page 2 of 6
Week 9 Discussion: Fundamentals of Nursing prevent unsafe increases in the patient's PaO2, which could result in apnea. In general, use a delivery system such as a Venturi mask or nasal cannula. Avoid routine use of a non-rebreather mask with 15 L/min of oxygen, unless the patient is not responding to lower flow rates. In some patients with chronic carbon dioxide retention, high flow oxygen may cause respiratory depression with the rapid rise in oxygen depressing the central ventilatory drive. What is the first thing the nurse should do when they enter the room of a patient who is short of breath? Some of the following things may be done simultaneously. Obviously, if it is an emergency situation, nursing assessment and interventions may need to be altered to fit the situation. This is where critical thinking skills should go into action. Maybe I am reading too much into it, but I do not know from reading this question if this is a patient with chronic dyspnea or acute dyspnea. I do not know the patient’s HX or previous DX. Is the dyspnea a new onset? Does the patient have Asthma, Cancer, COPD, etc.? Is the patient DNR or Full Code? It is imperative for me to know these things and other information in order to make the appropriate decision about the care of my patient.
Identify the patient. Assess the situation (order and type of treatment can depend on several different factors like patient HX and/or previous DX, emergent or chronic dyspnea, etc. Without doing an assessment 1st, you may not know the correct intervention/s to provide for the patient). o Is the patient restless or in obvious distress? o What does his/her facial expression tell me? o Ask the patient to rate breathlessness on a scale of 0 to 10. o Observe respiratory rate and depth o Check heart rate for tachycardia o Check SpO2 reading and/or ABG’s o Check capillary refill – is patient cyanotic? o Observe color and use of accessory muscles o Is there symmetric expansion of the chest? o Is there ↓ or ↑ fremitus? (This could actually tell me if the patient has a pleural effusion, pneumothorax, pneumonia, etc.). o Auscultate breath sounds Administer 2 L/min of O2 via N/C per M.D. order. Encourage the patient to cough and/or deep breathe every half hour to hour. Position in a high Fowler’s position - allows for good lung excursion and chest expansion.
Page 3 of 6
Week 9 Discussion: Fundamentals of Nursing Why are hospitals closely monitoring Catheter Acquired Urinary Tract Infections (CAUTI)? 9% of patients in hospitals acquire a health care-associated infection. UTI’s account for approximately 40% of them. The risk of catheter-associated urinary tract infections (CAUTIs) increases by the number of days that a catheter remains in place. “Value-based purchasing” is a quality improvement strategy explicitly linking payment with healthcare outcomes by paying more for better healthcare, and less for inferior care. Value-based purchasing could improve the quality of hospital care while also lowering health care costs. In many ways, the current hospital payment system is the antithesis of value-based purchasing because hospitals can receive additional payments when patients develop complications during their stay, including hospital-acquired infection. One approach is to hold hospitals financially accountable for not preventing complications. This strategy underlies the hospital payment rule change, implemented by CMS as the “Hospital-Acquired Conditions Initiative,” in which CMS will no longer pay hospitals extra when patients develop specific complications after admission. UTI’s are included in this ruling. What can the nurse do to prevent CAUTI?
Avoid the routine use of catheters; use only when clinically indicated. Collaborate w/health care providers to remove catheters when medical indications no longer exist. Suggest noninvasive continent devices such as condom catheters to reduce the risk of UTI and resulting complications. Nurses need to be patient advocates by taking an active role in monitoring duration of treatment. Follow good hand hygiene techniques. Do not allow the spigot on the drainage system to touch a contaminated surface. Only use sterile technique to collect specimens from a closed drainage system. If the drainage tube becomes disconnected, do not touch the ends of the catheter or tubing. Ensure that each patient has a separate receptacle for measuring urine to prevent crosscontamination. Prevent pooling of urine in the tubing and reflux of urine into the bladder. Avoid raising the drainage bag above the level of the bladder. Clamp the tubing or empty its contents to the drainage bag first, if it becomes necessary to raise the bag during transfer of the patient. Provide for drainage of urine from the tubing to the bag by positioning the tubing. Before exercise or ambulation, drain all urine from the tubing into the drainage bag. Avoid prolonged kinking or clamping of the tubing. Page 4 of 6
Week 9 Discussion: Fundamentals of Nursing
Empty the drainage bag at least every 8 hours. If large outputs, empty more frequently. Encourage fluid intake. Tape or secure the catheter appropriately for the patient. Perform routine perineal hygiene per agency policy and after defecation or bowel incontinence.
Page 5 of 6
Week 9 Discussion: Fundamentals of Nursing References
CDEM Self Study Modules. (n.d.). Retrieved from http://www.cdemcurriculum.org/ssm/pulm/copd/copd.php EHS: Nursing Diagnosis Care Plans, 4/e - Breathing Pattern, Ineffective. (n.d.). Retrieved from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick09.ht ml Potter, P. (2013). Fundamentals of nursing (Eighth ed.). St. Louis, MO: Elsevier Mosby. Saint, S., Meddings, J., Calfee, D., Kowalski, C., & Krein, S. (n.d.). Catheter-associated Urinary Tract Infection and the Medicare Rule Changes. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754265/
Page 6 of 6