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Peak funda/lmr raxo sept3
 

Peak funda/lmr raxo sept3

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ratinalization of peak post test funda and lmr last sept 2 by randel dalauta

ratinalization of peak post test funda and lmr last sept 2 by randel dalauta

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    Peak funda/lmr raxo sept3 Peak funda/lmr raxo sept3 Presentation Transcript

    • RANDEL DALAUTA,RN
    • Doctrine of Respondeat Superior
      “master servant rule”
      *liability:
      a. agent/employee – direct liability
      b. principal/employer – vicarious liability
      *criteria:
      a. establish the employee/employer relationship
      b. act must be committed as harm is done to the patient
      c. act must be committed with in the scope of employment
      Doctrine of Res ipsaLouitur
      “things speak for itself”
      3 conditions:
      a. injury does not normally occur unless there was negligence
      b. injury caused by an agent with in the control of the defendant
      c. plaintiff did not engage in any manner that would tend to bring
      about the injury
    • Captain of the Ship Doctrine
      “command responsibility”
      Force Majeure
      “superior force/irresistible force/ Act of God;fortuitous event”
      *liability:
      - free both parties from liability or obligation when extraordinary event or circumstances beyond the control of the parties
      - defendant must have nothing to do with the events happening
      *elements:
      a. Externality – defendant must have nothing to do with the event
      b. Unpredictability – if event could be forseen, the defendant is obliged to have prepared it.
      c. Irresistibility – consequences of the event must have been unpreventable.
      *not answerable unless
      a. Specified by Law
      b. Obligation require assumption of risk
      c. Stipulation
    • TORTS
      ASSAULT
      BATTERY
      FALSE IMPRISONMENT OR ILLEGAL DETENTION
    • Sec.4.The Rights of Patients
      (4) Right to Information
      In the course of his/her treatment and hospital care, the patient or his/her legal guardian has a right to be informed of the result of the evaluation of the nature and extent of his/her disease, any other additional or further contemplated medical treatment on surgical procedure or procedures, including any other additional medicines to be administered and their generic counterpart including the possible complications and other pertinent facts, statistics or studies, regarding his/her illness, any change in the plan of care before the change is made
    • Informed Consent
      “An informed consent is an autonomous authorization by individuals of a medical intervention or of involvement in research”
      Element:
      the nature of the decision/procedure
      reasonable alternatives to the proposed intervention
      the relevant risks, benefits, and uncertainties related to each alternative
      assessment of patient understanding
      the acceptance of the intervention by the patient
      *patient must be competent & consent voluntarily given
      *competence should be determined by professionals, approved by the court under the law.
    • When medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information.
    • The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
    • Competence
      Criteria/elements
      Determinant
      On the basis of the
      law
      Legal age
      • Not under influence or against freewill
      Autonomy
      • Sound mind
      Expert and approved by the court
      • Not suffering from physical disability such as those who are mentally incompetent
    • Emphysema vs Chronic Bronchitis
      Chronic Bronchitis
      Emphysema
      Chronic Bronchitis
      Emphysema
      Pink puffer
      Blue Bloater
      Acyanotic
      Cyanotic
      Alveolar destruction
      Bronchial Inflammation
      P’s
      Persistent SOB
      Progressive Dyspnea
      Prominent Barrel Chest
      C’s
      Chronic cough
      Copious sputum
      Priority: COMFORT
      COR PUMONALLE
    • METHODS OF CARE DELIVERY
      a. PRIMARY NURSING
      - total care; 24/7
      - sole accountability
      b. CASE METHOD
      - Oldest Method; 1:1
      - client centered
      - e.g. ICU nurse
      c. FUNCTIONAL METHOD
      - 1nurse 1 task
      - task oriented
      d. TEAM METHOD
      - 1 team 1 group of patient
      - collaboration oriented
      * team composition
      a. RN team leader c. Nursing Aides
      b. License Practical nurse
      e. CASE MANAGEMENT
      - management of specific case through out hospitalization
      * criteria of cases:
      a. with specific physician c. by diagnosis
      b. geographic proximity
    • Readiness to Learn
      Types
      a. Physical Readiness (Skills)
      - focus away from physical
      status
      - anything that using up energy
      and time
      b. Emotional readiness (Attitude)
      - ready/asking about self care
      activities
      - not ready: extremely anxious,
      depressed, & grieving
      c. Cognitive(Knowledge)
      - asking about the disease process
      - cause & details
      Remember:
      client is ready if;
      - Ask questions
      - Search information
      -Knowingly shows interest
      client is not ready if;
      - Lack of attention
      - Avoid subjects when brought up
      - Missed appointments
      - Express disinterest
      Nurse Role:
      Providing physical & emotional support
      Providing opportunities to learn
    • How to Increase Motivation
      Relating the learning to values
      Encouraging self direction &
      independence
      Assisting client identify benefits of changing behavior
      Create learning situation which likely for success (small/easy task)
      Helping make learning pleasant & nonthreatening
      (+) - reinforcement
      - attitude demonstrated by the nurse
    • maslow's hierarchy of needs
    • Communication
      the exchange of thoughts, feelings, and other information
    • Evidence of Mental health
      Basic needs meet
      Effective Coping Skills
      Emotional stability
      Satisfying relationship
      + self concept
    • Using An Extinguisher
      Pullthe Pin on the extinguisher
      Aimthe nozzle of the extinguisher at
      the base of the fire
      Squeezethe trigger
      Swipethe nozzle sideways
    • DIFFERENT Precautions
    • Simple Formula
      IVF
      C to F :Centigrade x 1.8 + 32 = F
      Temp
      F to C: Fahrenheit – 32 / 1.8 = C
      Desired
      Available
      Meds
      Quantity
    • Enema
    • Enema
    • Miller-abott tube
    • Subcutaneous emphysema
    • OBJECT PERMANENCE – realization that something out of sight still exist, occurs in the later stages of sensorimotor stage development.
      EGOCENTRIC SPEECH – occurs when the child talks just for fun and cannot see another point of view.
      ANIMISM– all inanimate objects are given living meaning
      GLOBAL ORGANIZATION – means that if any part of an object or situation changes, the whole thing has changed.
    • Cerebral Palsy
      Rhizotomy
      - locate and cut dorsal root of the nerve that provide over stimulation to specific parts of the body
      Aspiration precaution
      - thickened feeding
      - add rice to the food
      Drugs
      - Methocarbamol (Robaxin) muscle relaxant
      - Baclofen (Lioresal) treat spacity(palambotngkatawan)
    • TONSILECTOMY
      AVOID
      C
      C
      R
      A
      *Milk & Milk products, blowing of nose
      DIET
      Cool clear liquid
      Ice chips
      Gelatin
      Ice pop/Popsicle
      Fruit sherbet
      Apple juice
      itrus, carbonated food
      rying, coughing,
      Clearing throat
      ed/Brown Colored Foods
      Rough Foods
      spirin
    • CHF
      • Post-op priority: prevent trauma to suture line
      • Logan’s Bar – to avoid trauma
      • Elbow restraints
      • UP/Dorsal
      • Down/Ventral
      • Prone to infection
      • Less Prone
      • Cpx: Chordee
      • Cpx: Extrophy of the Bladder
      Surgery:
      Meatotomy
      Urethroplasy
      Circumcision – skin graft
      Intervention: post-op
      Urinary Diverion /Stent
      Avoid tub bath until stent remove
      Asses patency of stent
      Pain Meds
      Anti cholinergic – relieve spasm
      Increase Fluid Intake
      Follow up check after 4 days
      Remember:
      • Do not circumcise right after birth
      • Surgery before toilet training (2 y.o.)
      • Asses stream of Urine
    • USE OF PROTECTIVE EQUIPMENT
    • Kaposis sarcoma
    • Acute cellulitis
    • Nasogastric Tube
      Insertion:
      - NEX
      - High Fowler’s position
      - Sips of water and advance tube as client swallows
      - Do not force the tube!
      Confirm placement of NGT
      Monitor and record residual volume q4h by aspirating stomach content with a syringe. A residual volume of >100-150 ml indicates delayed gastric emptying. Notify MD.
      During and after feeding keep HOB 30 degrees to prevent aspiration; For continuous feedings, keep the patient in a semi-Fowler’s position at all times
      Flush/Irrigate tube feeding with 30-60ml of water q4h during continuous feeding, before and after each intermittent feeding, before and after administering meds, after each time you check residual volume
      Feeding set changed q24h. Bag rinsed q4h.
    • LMRjuris
    • Human Motivational Theory
      • Theory A
      • -American style
      • - Predominantly downward communication pattern
      • - Rapid evaluation & promotion
      • - Segmented concern for employees
    • Theory X and Theory Y (Douglas Mc Gregor, 1960)
    • Theory Z (William Ouchi, 1981)
      • - promotes a relationship-oriented, democratic leadership style
      • - work is natural & a source of satisfaction
      • Elements:
      • 1. Collective decision making
      • 2. Long term employment
      • 3. Slower but more predictable promotions
      • 4. Holistic concern for employees
    • Social System Model for Hospitals
      Environment
      Outputs
      Inputs
      Process Structure
      People
      Staff
      Patients
      Material
      • Drugs & chemicals
      • Equipment
      • Diet
      Money
      • To maintain staff, facilities & procure materials
      Communication
      • Between *Upward
      • Downward *Lateral
      Decision Making
      For:
      • Cure, Diagnosis, Treatment
      • Patient Care
      • Procurement of materials
      Action:
      • Putting decisions into practice
      • Balanced mix of communication,
      decision making & action
      STANDARDS
      EFFICIENT PATIENT CARE
      • Lesser hospital stay
      • Improve vitals sign
      • Zero infection & complications
      Discrepancy between Actual and Expected Performance
    • Types of Budget
      a. Open-ended Budget - single cost estimate
      b. Fixed ceiling Budget - uppermost spending limit
      - set by the top executive
      c. Flexible Budget - set for each level of activity or different operating conditions
      d. Performance Budget - based on the function and activities of personnel
      e. Program Budget - program budget cost
      f. Zero-based Budget - justifies in detail the cost of all programs
      - old and new
      g. Sunset Budget - designed to self destruct within a prescribed period to ensure cessation of the funded program
    • Managerial Level
      Top Level manager
      - organizational decision makers
      - commands over the middle manager
      - conceptual ability; strategic (long term planning)
      Middle manager
      - coordinate nursing activities to several nursing units
      - receive broad strategies & policies from to managers
      - supervise 1st line managers
      FirstLevel manager
      - in-charge of day to day operation
      - responsible for non managerial staff
      - clinical operation in-charge
      e.g. nursing supervisor
    • Different leadership styles:
      • 1. Autocratic
      • -leaders exert total control over members
      • 2.Democratic/
      • Participative
      • -leader shares control with group members
      • 3. Laissez-faire/
      • Permissive/
      • ultraliberal
      • -leader relinquishes control to group members.
    • 4.Consultative Leadership
      • -focuses on using the skills, experiences, and ideas of others
      • - leader: retains the final decision-making power (veto power)
      • - involved others in decision making
      • 4. Multi critic/ Situational/ Contingency
      • -leader utilizes varying styles depending on the situation
      • - should be complementary to manager’s style, expectations & characteristics of workers
      • -how to accomplish? “Aligning closely the forces in the manager, worker & situation”
    • Elements of Bureaucracy
      Division of labor
      Hierarchy of authority
      Impersonality
      Employment based on technical qualifications
      Structured written rules & regulation
    • METHODS OF CARE DELIVERY
      a. PRIMARY NURSING
      - total care; 24/7
      - sole accountability
      b. CASE METHOD
      - Oldest Method; 1:1
      - client centered
      - e.g. ICU nurse
      c. FUNCTIONAL METHOD
      - 1nurse 1 task
      - task oriented
      d. TEAM METHOD
      - 1 team 1 group of patient
      - collaboration oriented
      * team composition
      a. RN team leader c. Nursing Aides
      b. License Practical nurse
      e. CASE MANAGEMENT
      - management of specific case through out hospitalization
      * criteria of cases:
      a. with specific physician c. by diagnosis
      b. geographic proximity
    • Communication steps
    • Changing people’s behavior
    • CONFLICT RESOLUTION:
      Avoidance – reduce tension
      Accommodation - self sacrifice
      Collaboration – mutual attention
      Compromise - both seek acceptable solution
      Withdrawing – one party is removed
      Forcing – immediate end but cause unresolved
    • “MANAGEMENT BY LIBRO”
      By the book established rules, systematic & analytical
      “MANAGEMENT BY KAYOD”
      Hard working, dedication, INTROVERT & formal
      Content oriented
      “MANAGEMENT BY UGNAYAN”
      Situational, integritive, most ideal pinoy manager
      “MANAGEMENT BY OIDO”
      By ear, based on practical
      “MANAGEMENT BY LUSOT”
      Avoid much work, extrovert, & informal
      Process oriented
    • Total Quality Management (TQM)
      • Based on theory Y & Z
      • Centered on QUALITY
      • Based on all member participation/involvement
      • Aim is long term success & improvement
      • Achieve customer satisfaction
    • Hypothesis vs Assumption
    • www.nursendoutfield.blogspot.com
    • CLASSIFICATION OF PERSONS CRIMINALLY LIABLE:
      ACCOMPLICE:
      a person who cooperates
      “ accessory before the fact”- absent at the time crime is committed.
      Principal:
      a. By direct participation- doer of the act
      b. By inducement-directly force or induce others
      c. By cooperation- indispensable
      ACCESSORY:
      “accessory after the fact”
      a. Profits
      b. Conceals/ destroys evidence
      c. Assists in the escape of the principal
    • Administering Ear Medications
      Place the client in a side-lying position with the affected ear facing up.
      Straighten the ear canal by pulling the pinna down and back for children less than 3 years of age or upward and outward in adults and older children.
      Instill the drops into the ear canal by holding the dropper at least 1⁄2 inch above the ear canal
      Ask the client to maintain the position for 2–3 minutes.
    • Catheterization
    • Length of catheter insertion
      male: 6-9 inches
      female: 3-4 inches
    • Enema
      Prepare the solution, assure temperature within range of 99° to 102°F by using a thermometer or placing a few drops on your wrist.
      Wash hands and don gloves.
      Assist patient to left side-lying position, with right knee bent.
      Hang bag of enema solution 12 to 18 inches above anus.
      Lubricate 4 to 5 inches of catheter tip.
      Separate buttocks, insert catheter tip into anal opening, slowly advance catheter approximately 4 inches.
      Slowly infuse solution via gravity flow
      If client complains of increased pain or cramping, or if fluid is not being retained, stop procedure, wait a few minutes, then restart
      Clamp tubing when fluid finishes infusing; remove catheter tip.
      Assist client to bedpan, commode, or toilet;
    • Enema
      If “enema till clear” is ordered, no more than 3 L fluid should be administered in any one series of enemas. Repeated enemas produce irritation of bowel mucosa and perianal area, as well as electrolyte loss and exhaustion. If returns are not clear, consult physician for further instructions.
    • Transmission Based Precaution
    • Anaphylactic Reaction
      acute systemic hypersensitivity reaction that occurs within seconds or minutes after exposure to certain foreign substances
    • Anaphylactic Reaction
      • Ask the patient about PREVIOUS ALLERGIES
      • Avoid giving PARENTERAL MEDICATIONS unless absolutely necessary
      • Perform a SKIN TEST (negative skin test results do not always indicate safety)
      • Outpatient, keep at least 30 minutes after injection
      • Wear medical identification tags or bracelets
      MANAGEMENT
      • airway and ventilation is essential
      • aqueous epinephrine administered
    • Anaphylactic Reaction
      LIMITING EXPOSURE TO STINGING INSECTS
      • Avoid places where stinging insects congregate
      • Wear adequate covering
      • Avoid perfumes, scented soaps, and bright colors
      • Keep car windows closed
    • Anaphylactic Reaction
      If stung:
      • Inject self immediately with EPINEPHRINE
      • Remove the stinger with one quick scrape of the fingernail. (Do not squeeze)
      • Clean with soapy water, and apply ice.