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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  • 1. RANDEL DALAUTA,RN
  • 2.
  • 3.
  • 4.
  • 5. 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
  • 6. 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
  • 7. TORTS
    ASSAULT
    BATTERY
    FALSE IMPRISONMENT OR ILLEGAL DETENTION
  • 8. 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
  • 9. 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.
  • 10. 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.
  • 11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. maslow's hierarchy of needs
  • 17. Communication
    the exchange of thoughts, feelings, and other information
  • 18. Evidence of Mental health
    Basic needs meet
    Effective Coping Skills
    Emotional stability
    Satisfying relationship
    + self concept
  • 19.
  • 20. Using An Extinguisher
    Pullthe Pin on the extinguisher
    Aimthe nozzle of the extinguisher at
    the base of the fire
    Squeezethe trigger
    Swipethe nozzle sideways
  • 21. DIFFERENT Precautions
  • 22. 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
  • 23. Enema
  • 24. Enema
  • 25. Miller-abott tube
  • 26. Subcutaneous emphysema
  • 27.
  • 28. 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.
  • 29. 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)
  • 30. 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
  • 31. CHF
  • 32.
    • Post-op priority: prevent trauma to suture line
    • 33. Logan’s Bar – to avoid trauma
    • 34. Elbow restraints
  • 35. 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
    • 41. Surgery before toilet training (2 y.o.)
    • 42. Asses stream of Urine
  • 43.
  • 44. USE OF PROTECTIVE EQUIPMENT
  • 45. Kaposis sarcoma
  • 46. Acute cellulitis
  • 47. 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.
  • 48. LMRjuris
  • 49. Human Motivational Theory
    • Theory A
    • 50. -American style
    • 51. - Predominantly downward communication pattern
    • 52. - Rapid evaluation & promotion
    • 53. - Segmented concern for employees
  • Theory X and Theory Y (Douglas Mc Gregor, 1960)
  • 54. Theory Z (William Ouchi, 1981)
    • - promotes a relationship-oriented, democratic leadership style
    • 55. - work is natural & a source of satisfaction
    • 56. Elements:
    • 57. 1. Collective decision making
    • 58. 2. Long term employment
    • 59. 3. Slower but more predictable promotions
    • 60. 4. Holistic concern for employees
  • 61. Social System Model for Hospitals
    Environment
    Outputs
    Inputs
    Process Structure
    People
    Staff
    Patients
    Material
    Money
    • To maintain staff, facilities & procure materials
    Communication
    • Between *Upward
    • 64. Downward *Lateral
    Decision Making
    For:
    • Cure, Diagnosis, Treatment
    • 65. Patient Care
    • 66. Procurement of materials
    Action:
    • Putting decisions into practice
    • 67. Balanced mix of communication,
    decision making & action
    STANDARDS
    EFFICIENT PATIENT CARE
    • Lesser hospital stay
    • 68. Improve vitals sign
    • 69. Zero infection & complications
    Discrepancy between Actual and Expected Performance
  • 70. 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
  • 71. 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
  • 72. Different leadership styles:
    • 1. Autocratic
    • 73. -leaders exert total control over members
    • 2.Democratic/
    • 74. Participative
    • 75. -leader shares control with group members
    • 3. Laissez-faire/
    • 76. Permissive/
    • 77. ultraliberal
    • 78. -leader relinquishes control to group members.
  • 4.Consultative Leadership
    • -focuses on using the skills, experiences, and ideas of others
    • 79. - leader: retains the final decision-making power (veto power)
    • 80. - involved others in decision making
    • 4. Multi critic/ Situational/ Contingency
    • 81. -leader utilizes varying styles depending on the situation
    • 82. - should be complementary to manager’s style, expectations & characteristics of workers
    • 83. -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
  • 84. 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
  • 85. Communication steps
  • 86. Changing people’s behavior
  • 87. 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
  • 88. “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
  • 89. Total Quality Management (TQM)
    • Based on theory Y & Z
    • 90. Centered on QUALITY
    • 91. Based on all member participation/involvement
    • 92. Aim is long term success & improvement
    • 93. Achieve customer satisfaction
  • Hypothesis vs Assumption
  • 94. www.nursendoutfield.blogspot.com
  • 95. 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
  • 96. 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.
  • 97. Catheterization
  • 98. Length of catheter insertion
    male: 6-9 inches
    female: 3-4 inches
  • 99. 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;
  • 100. 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.
  • 101. Transmission Based Precaution
  • 102. Anaphylactic Reaction
    acute systemic hypersensitivity reaction that occurs within seconds or minutes after exposure to certain foreign substances
  • 103. Anaphylactic Reaction
    • Ask the patient about PREVIOUS ALLERGIES
    • 104. Avoid giving PARENTERAL MEDICATIONS unless absolutely necessary
    • 105. Perform a SKIN TEST (negative skin test results do not always indicate safety)
    • 106. Outpatient, keep at least 30 minutes after injection
    • 107. Wear medical identification tags or bracelets
    MANAGEMENT
    • airway and ventilation is essential
    • 108. aqueous epinephrine administered
  • Anaphylactic Reaction
    LIMITING EXPOSURE TO STINGING INSECTS
    • Avoid places where stinging insects congregate
    • 109. Wear adequate covering
    • 110. Avoid perfumes, scented soaps, and bright colors
    • 111. Keep car windows closed
  • Anaphylactic Reaction
    If stung:
    • Inject self immediately with EPINEPHRINE
    • 112. Remove the stinger with one quick scrape of the fingernail. (Do not squeeze)
    • 113. Clean with soapy water, and apply ice.