Safety
Name 3 aspects of handwashing
- wash 15 s with soap/water
- turn off handle with clean towel
- air dry after washing (including with sanitizer)- provides full antiseptic effect
Name 3 tasks that can be safely delegated to UAP?
VS, I&O's, applying restraints
No unstable patients or nursing care
Ensuring patient understands procedure/surgery and give consent willingly. Does NOT explain procedure, risks, benefits, etc.
Craft a note for a patient you found on the floor upon walking into the patient's room
"Patient found on floor, VS obtained, physician notified"
Management of shortness of breath symptoms for the COPD patient would be considered what type of service?
Palliative= symptom management
Hospice= end of life management
What are the 4 P's?
Potty, personal belongings, pain, position
What must the nurse do at the end of delegation in order to ensure tasks were safely completed?
Appropriately supervise care (check VS, interventions were completed, etc.)
Give an example of nursing autonomy and integrity
(owning mistakes)
A patient that had a stroke with speech deficits would benefit from being transferred to what type of facility post acutely?
Rehab
What about someone needing IV antibiotics?
Name 2 items that can done while getting ready to bathe a patient?
Put up side rails, turning patient, communicating, assessing
What are the rights for administering medications?
Right patient, dose, medication, and route.
A nurse delegates oral care of an unconscious patient to the UAP. What interventions might the nurse suggest prior to delegation of this task?
Turn the patient on their side, have suction available, etc.
How does the nurse provide for patient autonomy with morning ADL's?
Ask the patient which order or tasks they want to complete first
Assessment
Ask questions!
Identify needs!
You have to prioritize patient in the ER. Who should be seen first?
ABC's
SOB, tachycardic, etc.
Name 3 interventions for the patient that has begun to seize
Get suction, turn to side, loosen tight clothing, time seizure, etc.
Evaluation of care plan and adjustments
If a patient is angry about a policy, what can the nurse due to validate the patient's feelings while still upholding hospital policy?
"It is understandable that you are upset, however..."
Do not apologize
As a nurse is doing hourly rounds, they find their patient is angry, restless, and states "Go talk a long walk off a short pier". Which subjective information should the nurse document?
"Go talk a long walk off a short pier"
Name 3 items that increase the patient's risk for developing a pressure injury
Incontinence, immobile, sweaty, malnourished, low braden score (< 9)
Who can apply restraints and why are restraints ordered?
UAP, RN, LPN, ordered if impeding care (picking at lines/tubes/drains)
2x2 (6+4)
40
Say an assertive nursing statement relating to a patient's unmet pain needs
What are some assessment priorities for the patient with shortness of breath related to viral pneumonia?
Breath sounds, chest pain, clubbing, nail beds (cap refill), etc.
What did the fish say when he ran into the wall?
DAM!