Week 3 Critical thinking, clinical judgement, admissions, transfers, discharge, client saftey

Question 1

Critical thinking

Answer 1

-life-long learning
-seeking truth, open-minded, thinking about why something is effective/ineffective
-critical thinking is a systematic process/pattern, using reason to guid decisions
-critical thinking includes …

Reflection: gain insight from past events
Language: clear/precise
Intuition: gut feeling, use data to confirm/disprove the feeling

Question 2

**Levels of Critical Thinking

Answer 2

1. Basic critical thinking- nurse trusts the experts
2. Complex Critical thinking: nurse has autonomy by analyzing and examining data to determine the best alternative
3. Commitment: nurse makes choices w/out help, fully responsible

Question 3

Levels of critical thinking review

Answer 3

Basic->Complex->Commitment

Question 4

Components of Critical Thinking**
CAKES

Answer 4

Competences- decision making, reasoning, problem solving
Attitudes: confidence, fair, perseverance etc
Knowledge: nurse edu/training
Experiences: goes into intuition
Standards:

Question 5

review critical thinking and AAPIE
Assesment

Answer 5

data collection of client health status

critical thinking skills:
observe, good techniques when collecting data, differentiate relevant data, organize and validate data

Question 6

Analysis and critical thinking

Answer 6

interpreting data to reach an appropriate nsg judgment
-know clusters/cues, inferences, knowing the potential problem or risk, no judgments

Question 7

review the AAPIE and critical thinking in ppt

Question 8

Nsg and Discharges

Answer 8

begins at admission
establish if the client can participate in the admission assessment
establish the therapeutic relationship with Pt and family at admission
promote professionalism

Question 9

Admission Process**

Answer 9

Equipment:
-anything necessary for room, doc forms,
-equipment for vitals, pulse oximeter, hospital attire

Procedure
-Introduce your name and title
-give hospital wear
-facility brochures and info material
-info on advance directives*
-document advance directives status in med record*

Question 10

Admission Assessment

Answer 10

Baseline: vitals, height, weight, allergies

Biographical info - wear do you live? is a a two floor?
Clients reason for seeking health care
Present illness and findings
Health History

Question 11

Health History on admission assessment acronym

Answer 11

SAMPLE
Symtoms
Allergies
Medications
Past medical history
Last PO intake
Events leading to visit

Question 12

Admission assessment

Answer 12

family history of serious illness
pschosocial assessment
-alc, tobacco, drugs, caffeine
-any mental illness
-abuse or homelessness
-home situation/ sig other
Nutrition
-diet, any dysphagia?
-weight
-supplements/herbal OTC
-dentures

Question 13

Admission Assessment

Answer 13

Spiritual health/quality of life concern
Review of body systems: head to toe exam, any alterations
Safety assessments: fall risk, sensory deficits, assistive devices
Discharge info- fam in the home, transportation for discharge, phone numbers, medical equipment, home health care needs, stairs at home

Question 14

Admission cont

Answer 14

Inventory of all personal items/devices
Orientations
-call light op, bed op, services, tv controls, lighting op, smoking policy, restroom locations, waiting areas, meal times, time for visits/policies

Question 15

TRANSFER

Answer 15

-have special equipment ready
inform clients roommate of admission
-inform team of arrival and needs
-meet with client and fam at arrival to start admission process and orient pt/fam
asses how the client responds to transfer
documentation
implement any needed interventions

Question 16

Transfer domumentation

Answer 16

Dx and care
demographic info
health status, plan of care, recent changes
meds, vitals
allergies
diet and activity orders
equipment and adaptive devices needs : vitals, suctioning, wheelchair
advance directives, emergency code status in medical history
family involvement in care

Question 17

Discharge process

Answer 17

Indication for transfer and discharge
changes in level of care needed
-another setting is needed

Question 18

Discharge planning

Answer 18

can pt ability to return home?
-does the pt have assitance at home?
-note any needed devices
-document pt discharged
-involve pt/family in discharge planning

Question 19

Discharge edu

Answer 19

provide copy of clear instructions/discuss
-verify pt understanding
Standards:
-note safety issues at home
-review potential issues, and how to contact provider/emergency services
-give provider phone number
-phone # of community resources
-step-by-step instructions for continuing tx
-dietary restrictions guidelines, including interactions with meds
-enforce amount of therapies to do at home
-directions on medications, interactions, adherence, SEAE

Question 20

Discharge Equpment

Answer 20

personal belongings
valuables from the safe
medications
assistive devices
medical records or a transfer form*

Question 21

Discharge Px

Answer 21

-if transferring, confirm with facility or unit to expect the client
-communicate time of transfer to the receiving unit
-complete documentation, med rec, transfer form
-verbal transfer report by phone
-confirm the mode of transportation for client
-make sure client is dressed appropriately
-valuables

Question 22

Discharge documentations

Answer 22

types: Provider prescription vs against medical advice AMA
date/time of discharge, who went with the client, and transportations, wheelchair to car, gurney to ambulance
-where the client went (home, facility)
-any unresolved issues, px, follow-up
-disposition of valuables, meds brought from home, prescriptions

Question 23

Safety Nsg Action

Answer 23

use risk assessment for pt safety to environment
-encourage pt to speak up/active role
-culture of checks and balances
-speak of risk factors
-protocols for dangerous situations
-quality care priorities
know location of safety data sheets and hazardous chemicals in the environment

Question 24

Falls at risk

Answer 24

elderly: impaired balance/mobility, improper use of mobility aids, unsafe clothing, environment, low endurance, low sensory
-impaired vision, weakness, urinary frequencies, balance problems,
cerebral palsy injury MS
cognitive dysfunctions
reactions to meds orthostatic hypotension drowsy

Question 25

Fall prevention

Answer 25

fall risk assesment
fall risk alerts (bands on wrists)
-orientate call light, assistive devices
-lighting
-place at risk pt by nurse stations
-put frequent use items at bedside
-bed low/locked

Question 26

fall prevention

Answer 26

-footwear
-gait belt
-clean floor
- electronic monitoring devices
report and document all incidents to prevent future incidents

Question 27

Seizures

Answer 27

-sudden surge of electrical activity in the brain
-due to epilepsy, fever, medical issues

Partial seizure/focal: electrical surges in one hemisphere of brain
Generalized seizure: both hemispheres of brain involved
status epilepticus a prolonged seizure is a medical emergency

Question 28

Seizure precautions

Answer 28

-rescue equipment: oxygen, oral airway, suction equipment, padding for side rails, saline lock for immediate IV access
-inspect environment for things that cause seizure
-assist clients at risk with ambulation

Question 29

Seizures during

Answer 29

stay beside pt
call for help
keep airway open, suction as needed
note duration, sequence, and movements
-post seizure determine mental status, ox saturation, vital signs, explain what happened, comfort, understanding
-document the seizure and movements, injury, durations, aura, postictal state as well.

Question 30

Seclusion and restraint

Answer 30

-shortest duration necessary if less restrictive methods are not working
-physical: mitt, belt, limp, vest
-chemical: sedatives, neuroleptic, psychotropic med
-it can cause complications: Pnuemonia, Incontinence, Pressure injuires*
Restraints should:
never interfere with Tx
restrict as little as is necessary
fit well and discreetly
be easy to remove

Question 31

Restraint prescription***

Answer 31

-Provider prescription must be in writing, or face-to-face
-must include the reason for restraint, type, location on body, duration, and behaviors that warrant restraint
-only 4 hr restraints for adults
2 hr restraints for pt 9-17
1 hr restraints for clients younger than 9
providers can renew prescriptions with a max of 24 consecutive hours

Question 32

Restraints Nsg role

Answer 32

assess skin
offer food/fluid
provide hygiene/elimination
-vitals monitor
-ROM exercise
-Pad bony extremities
secure restraints on movable parts of bed frame
-use buckle straps or quick release knot
replace restraints often
-Never leave a client alone with a restraint
-monitor if use is still needed

Question 33

Restraint doc

Answer 33

events prior to restraining
-other actions to avoid restraints
-time of application/removal
-type of restraint/location
-type and frequency of cares ROM, nero chekc, removal, skin chekcs
condition of the restrained body part
response at removal of the restraints
med administrations

Question 34

Fire Safety

Answer 34

know exits, alarms, extinguishers, and oxygen shut off valves **
keep fire doors unblocked
know the evacuation plan

Question 35

RACE

Answer 35

RACE
Rescue- pt
Alarm-facility alarm system report the fires details and location
Contain - closing doors, shutting off oxygen source, electrical devices, ventilate clients who are on life support with a bag-valve mask
Extinguish-

Question 36

fire extinguishing
PASS

Answer 36

Pull the pin
Aim at the base of the fire
Squeeze the handle
Sweep the extinguisher from side to side covering the area of the fire