Fundamentals ATI Proctored exam Study Guide

• Levels of health care
-Preventative health care focuses on educating and equipping clients to reduce and control risk factors of disease. Examples include programs that promote immunization, stress management, and seat belt use.
-Primary health emphasizes health promotion, and includes prenatal and well-baby care, nutrition counseling, and disease control. This level of care is based on a sustained partnership between the client and the provider. Examples include office or clinic visits and scheduled school or work-centered screenings (Vision, hearing, obesity).
-Secondary health care includes the diagnosis and treatment of emergency, acute illness, or injury. Examples include care that is given in hospital settings (inpatient and emergency departments), diagnostic centers, or emergent care centers.
-Tertiary health care involves the provision or specialized highly technical care. Examples include oncology centers and burn centers.
-Restorative health care involves intermediate follow up care for restoring health. Examples include home health care, rehabilitation centers, and in-home respite care.

 Nursing ethical principles
o Autonomy
-Ability of the client to make personal decisions, even when those decisions may not be in the clients own best interest.
o Beneficence
-Agreement that the care given is in the best interest of the client; taking positive actions to help others.
o Fidelity
-Agreement to keep ones promise to the client about care that was offered.
o Justice
-Fair treatment in matters related to physical and psychosocial care and use of resources.
o Nonmaleficience
-Avoidance of harm or pain as much as possible when giving treatments.
o Veracity
-It is the basis of the trust relationship established between a patient and a health care provider.
• Ethical decision making in nursing
o Ethical dilemmas are problems about which more than one choice can be made and the choice made is influenced by the values and beliefs of the decision makers. These are common in health care, and nurses must be prepared to apply ethical theory and decision making to ethical problems.
o A problem is an ethical dilemma if:
-It cannot be solved by a review of scientific data.
-It involves a conflict between two moral imperatives.
-The answer will have a profound effect on the situation/client.
 The nurses basic code of ethics and principles remains constant. These basic principles include:
o Advocacy
-Support of the cause of the client regarding health, safety, and personal rights
o Responsibility
-Willingness to respect obligations and follow through on promises
o Accountability
-Ability to answer for one’s own actions
o Confidentiality
-Protection of privacy without diminishing access to quality care.
 Intentional torts
o Assault
-The conduct of one person makes another person fearful and apprehensive (Threatening to place a nasogastric tube in a client who is refusing to eat).
o Battery
-Intentional and wrongful physical contact with a person that involves an injury or offensive contact (restraining a client and administering an injection against his/her wishes).
o False imprisonment
-A person is confined or restrained against his will (Using restraints on a competent client to prevent his leaving the care facility).
 Unintentional torts (didn’t intend to harm patient but you did)
o Negligence
-A nurse fails to implement safety measures for a client who has been identified as at risk for falls.
o Malpractice (Professional negligence)
-A nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies.
 Informed Consent
o Responsibility of the provider
 Communicate purpose of procedure, and complete description of procedure in the patients primary language (use medical interpreter if needed, NOT family member).
 Explain Risks vs. benefits
 Describe other options to treat the condition.
o Responsibility of the RN:
 Make sure provider gave the patient the above information.
 Ensure patient is competent to give informed consent (i.e. patient is an adult or emancipated minor, not impaired)
 Have patient sign consent document
 If pt has further questions call provider and have them come back and explain things further BEFORE they sign the form
• Patient Education
o Assessment: identify patient needs, learning style (auditory, visual, kinesthetic), abilities, available recources.
o Planning: develop mutually agreeable goals/outcomes.
o Implemmentation: DO NOT use medical jargon. Make sure materials are at a sixth grade level (or below).
o Evaluation: ask patient to explain the teaching in their own words, or have the patient do a return demonstration for psychomotor learning.
o DO NOT perform patient teaching when client is: in pain or has anxiety, or is in any way mentally impaired.
 Advance Directives
o Living will: communicates patients wishes regarding medical treatment if patient becomes incapacitated.
o Durable power of attorney (health care proxy): patient designates health care proxy to make medical decisions for them if they become incapacitated.
o Provider’s orders: prescription for DNR (do not resuscitate) or AND (allow natural death)
o Mandatory Reporting for RNs:
 Suspicion of abuse (child, elderly, domestic violence)
 Communicable diseases to local/state health department (mandated by state).
 Nursing Documentation
o Objective data: what you see, hear, smell. Do not include opinions or interpretations of data.
o Recording subjective data: document as direct quotes, or clearly identify information as a statement by patient.
o Legal guidelines for documentation:
 Don’t leave blank spaces in documentation.
 Never use correction tape or fluid or scratch out or black out words
 Include name and title on documentation
 Incident reports
o When accident occurs (falls or med error)
 Used for quality improvement for facility (for hospital)
o Not part of the patients records and should not be referenced in the patients record
 Need to document the incident and patient’s reaction and incidence report is for the hospital not for the patient’s medical record
 Telephone Orders and Information Security
o Telephone orders: have second RN listen in on call, repeat prescription back, make sure provider signs prescription within 24 hour.
o After provider says the order you FIRST want to read back the order to the provider, To ensure it is accurate.
 Information security
o HIPAA: ensures the confidentiality of health information only those responsible for patient’s care may access the patient’s medical record.
 Don’t use patient names on public display boards
 Communication about a patient should happen in a private place or at nursing station.
 Password protect and do not share passwords
 Log off or lock computer when you walk away
 Do not share information with unauthorized people
o Code system can be used
 If pt doesn’t want to tell anyone they are at the hospital
 Delegation (VERY IMPORTANT)
 DO NOT DELGATE WHAT YOU CAN EAT; (Evaluate, Asses, Teach)
o What RN has to do
 Patient education
 Nursing judgement
 Assessment
 Blood transfusions
 Unstable patients
o What a PN can do (LPN)
 Med admin
 Enteral feedings
 Urinary catheter insertion
 Suctioning
 Trach care
 Wound care
 Reinforce patient teaching you (RN) have already done
 Can care for STABLE patients
o What a NAP/UAP/CAN
 Bathing
 Dressing
 Ambulating
 Toileting
 Feeding without swallowing precautions
 Positioning
 Vitals
 Specimens
 I+Os
 Basic CPR
o 5 Rights to Delegation
 Right task
 Repetitive noninvasive and not a lot of supervision
 Right circumstances
 Do not assign a patient who is unstable
 Right patient
 Competent and within their scope of practice
 Right direction and communication
 Specific details and timeline for completion and expectation for reporting findings back to you
 Right supervision and evaluation
 May need to intervene
 Provide feedback
 Nursing process:
o Assessment and data collection:
 What do you see, hear, feel?
 Collect objective and subjective data
 Verify that the data you collected is clear and accurate
 Do assessment BEFORE action.
o Analysis and data collection:
 What are priority problems?
 Interpret the information collected
 Identify an appropriate Nursing Diagnosis
 Document your diagnosis and communicate it to the healthcare team
 Determine the health team’s ability to help
 Cluster collected data
 Any patterns and trends
 Compare data you gathered from baseline
o Planning:
 How will you fix them?
 Prioritize the outcomes of care.
 Develop and modify plan of care.
o Implementation:
 What interventions?
 Organize and manage the clients care including safety, communication, culture, and delegation of tasks.
 Carry out clients plan of care
 Counsel and educate the client
o Evaluation:
 How well did the invertentions work?
 Compare actual outcomes with the planned/ expected outcomes
 Evaluate patients compliance
 Document clients response to plan
 Modify plan and reassess as needed
 Patient admission
o Document patients:
 Advanced directions ASAP
 Vital signs
 Allergies
 Height and weight
 Head to toe assessment
 Health history
 Spiritual or cultural considerations
o Assess their ability to swallow safely:
 Give a little water and assess what the patient does
 Any concern is NPO until swallow evaluation by speech language pathologist
o Assess safety:
 Implement fall precautions if appropriate.
o Patient belongings and inventory:
 Valuables should be sent home with family if possible or lock valuables in facility safe.
o Medication reconciliation:
 Very important
 Compare home meds with providers prescription
o Discharge planning:
 Starts AT ADMISSION!!!
 Patient transfer (one unit to another)
o Use SBAR:
 Hand off tool to use when giving report to next nurse
 (Situation, Background, Assessment, Recommendation)
 Discharging a Patient
o Included in patient discharge instructions:
 Patients diet and activity restrictions
 Detailed instructions for procedures to be done at Home (such as wound dressing changes).
 List of medications, when to take them, precautions regarding medications.
 Signs and symptoms of complications, when to seek medical attention.
 Follow up information and appointment
 Names and numbers of community resources or providers
• List the pertinent information that should be included in a transfer report:
o These should include demographic information, medical diagnosis, providers, an overview of health status (physical, psychosocial), plan of care, recent progress, any alterations that might become urgent or emergent situation, directives for any assessments or client care essential within the next few hours, most recent vital signs, medications and last doses, allergies, diet, activity, specific equipment or adaptive devices (oxygen, suction, wheelchair), advance directives and resuscitation status, discharge plan (teaching), and family involvement in care and health care proxy.
• Therapeutic Communication:
o What NOT to do:
 DO not ask ‘why’ questions; NEVER PICK WHY!!!
 Do not ask yes/no questions, except in the case of possible self harm.
 Do not focus on the nurse
 Do not explore
 Do not say “Don’t Worry”
o What to do:
 Respond to feeling tone
 Provide information
 Focus on the client
 Use silence (offer to stay with a patient)
 Use presence (stay and comfort a patient by just being there to hold their hand).
 ALWAYS GO WITH ANSWER THAT ALLOWS A PAITENT TO EXPRESS THEIR FEELINGS.
 SELCET “TELL ME MORE or HOW does that make you feel” ANSWERS.
• What patient do you see first?
o Consider:
 Unstable vs. stable; ALWAYS see patient who is unstable FIRST!
 Unexpected vs. expected; Ask are the symptoms expected or unexpected? See unexpected FIRST!
 ABCs: Always remember (Airway, Breathing, Circulation) if patient doesn’t have a patent airway seem them FIRST!!!!
 Acute vs. Chronic; example asthma attack or broken bone is acute (severe sudden onset), COPD or osteoporosis is chronic (long developing syndrome)
 Actual vs. potential; Actual (problem related to cause as evidenced/ manifested by the signs and symptoms), Potential (potential problem related to the cause; there are no signs and symptoms, because the problem has not occurred yet.
 Hand hygiene:
o When to use soap and water:
 Hands are visibly soiled
 Before eating meals
 After using the restroom
 Contact with bodily fluids
 Wash for > 15-20 seconds. Dry w/ clean paper towel before turning off faucet.
o Alcohol-based products
 3-5 mL of product