Peak funda/lmr raxo sept3


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

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Peak funda/lmr raxo sept3

  1. 1. RANDEL DALAUTA,RN<br />
  2. 2.
  3. 3.
  4. 4.
  5. 5. Doctrine of Respondeat Superior <br /> “master servant rule”<br /> *liability:<br /> a. agent/employee – direct liability<br /> b. principal/employer – vicarious liability<br /> *criteria:<br /> a. establish the employee/employer relationship<br /> b. act must be committed as harm is done to the patient<br /> c. act must be committed with in the scope of employment<br />Doctrine of Res ipsaLouitur<br />“things speak for itself”<br />3 conditions:<br />a. injury does not normally occur unless there was negligence<br /> b. injury caused by an agent with in the control of the defendant<br /> c. plaintiff did not engage in any manner that would tend to bring <br /> about the injury<br />
  6. 6. Captain of the Ship Doctrine<br />“command responsibility”<br /> Force Majeure<br /> “superior force/irresistible force/ Act of God;fortuitous event”<br /> *liability:<br /> - free both parties from liability or obligation when extraordinary event or circumstances beyond the control of the parties<br /> - defendant must have nothing to do with the events happening<br />*elements:<br /> a. Externality – defendant must have nothing to do with the event<br /> b. Unpredictability – if event could be forseen, the defendant is obliged to have prepared it. <br /> c. Irresistibility – consequences of the event must have been unpreventable.<br />*not answerable unless<br /> a. Specified by Law<br /> b. Obligation require assumption of risk<br /> c. Stipulation<br />
  8. 8. Sec.4.The Rights of Patients<br />(4) Right to Information<br /> 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<br />
  9. 9. Informed Consent<br />“An informed consent is an autonomous authorization by individuals of a medical intervention or of involvement in research” <br />Element:<br />the nature of the decision/procedure <br />reasonable alternatives to the proposed intervention <br />the relevant risks, benefits, and uncertainties related to each alternative <br />assessment of patient understanding <br />the acceptance of the intervention by the patient <br />*patient must be competent & consent voluntarily given<br />*competence should be determined by professionals, approved by the court under the law.<br />
  10. 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. <br />
  11. 11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.<br />
  12. 12. Competence<br />Criteria/elements<br />Determinant<br />On the basis of the <br /> law<br />Legal age<br /><ul><li>Not under influence or against freewill</li></ul>Autonomy<br /><ul><li>Sound mind</li></ul>Expert and approved by the court<br /><ul><li>Not suffering from physical disability such as those who are mentally incompetent</li></li></ul><li>Emphysema vs Chronic Bronchitis<br />Chronic Bronchitis<br />Emphysema<br />Chronic Bronchitis<br />Emphysema<br />Pink puffer<br />Blue Bloater<br />Acyanotic<br />Cyanotic<br />Alveolar destruction<br />Bronchial Inflammation<br />P’s<br />Persistent SOB<br />Progressive Dyspnea<br />Prominent Barrel Chest<br />C’s<br /> Chronic cough<br /> Copious sputum<br />Priority: COMFORT<br />COR PUMONALLE<br />
  13. 13. METHODS OF CARE DELIVERY<br />a. PRIMARY NURSING <br />- total care; 24/7<br /> - sole accountability<br />b. CASE METHOD <br /> - Oldest Method; 1:1<br /> - client centered<br /> - e.g. ICU nurse<br />c. FUNCTIONAL METHOD <br /> - 1nurse 1 task<br /> - task oriented<br />d. TEAM METHOD <br /> - 1 team 1 group of patient<br /> - collaboration oriented<br />* team composition <br />a. RN team leader c. Nursing Aides<br /> b. License Practical nurse<br />e. CASE MANAGEMENT <br /> - management of specific case through out hospitalization<br />* criteria of cases:<br />a. with specific physician c. by diagnosis<br /> b. geographic proximity<br />
  14. 14. Readiness to Learn<br />Types<br />a. Physical Readiness (Skills)<br /> - focus away from physical <br /> status<br /> - anything that using up energy <br /> and time<br />b. Emotional readiness (Attitude)<br /> - ready/asking about self care <br /> activities<br /> - not ready: extremely anxious, <br /> depressed, & grieving<br />c. Cognitive(Knowledge)<br /> - asking about the disease process<br /> - cause & details<br />Remember:<br />client is ready if;<br />- Ask questions <br />- Search information<br />-Knowingly shows interest<br />client is not ready if;<br />- Lack of attention<br />- Avoid subjects when brought up<br />- Missed appointments<br />- Express disinterest<br />Nurse Role:<br />Providing physical & emotional support<br />Providing opportunities to learn <br />
  15. 15. How to Increase Motivation<br />Relating the learning to values<br />Encouraging self direction & <br /> independence<br />Assisting client identify benefits of changing behavior<br />Create learning situation which likely for success (small/easy task)<br />Helping make learning pleasant & nonthreatening<br />(+) - reinforcement <br /> - attitude demonstrated by the nurse<br />
  16. 16. maslow's hierarchy of needs<br />
  17. 17. Communication<br />the exchange of thoughts, feelings, and other information<br />
  18. 18. Evidence of Mental health<br />Basic needs meet<br />Effective Coping Skills<br />Emotional stability<br />Satisfying relationship<br />+ self concept <br />
  19. 19.
  20. 20. Using An Extinguisher<br />Pullthe Pin on the extinguisher<br />Aimthe nozzle of the extinguisher at <br /> the base of the fire<br />Squeezethe trigger<br />Swipethe nozzle sideways<br />
  21. 21. DIFFERENT Precautions<br />
  22. 22. Simple Formula<br />IVF<br />C to F :Centigrade x 1.8 + 32 = F<br />Temp<br />F to C: Fahrenheit – 32 / 1.8 = C<br />Desired<br />Available<br />Meds<br />Quantity<br />
  23. 23. Enema<br />
  24. 24. Enema<br />
  25. 25. Miller-abott tube<br />
  26. 26. Subcutaneous emphysema<br />
  27. 27.
  28. 28. OBJECT PERMANENCE – realization that something out of sight still exist, occurs in the later stages of sensorimotor stage development.<br />EGOCENTRIC SPEECH – occurs when the child talks just for fun and cannot see another point of view.<br />ANIMISM– all inanimate objects are given living meaning<br />GLOBAL ORGANIZATION – means that if any part of an object or situation changes, the whole thing has changed.<br />
  29. 29. Cerebral Palsy<br />Rhizotomy<br /> - locate and cut dorsal root of the nerve that provide over stimulation to specific parts of the body<br />Aspiration precaution<br /> - thickened feeding<br /> - add rice to the food<br />Drugs<br /> - Methocarbamol (Robaxin) muscle relaxant<br /> - Baclofen (Lioresal) treat spacity(palambotngkatawan)<br />
  30. 30. TONSILECTOMY<br />AVOID<br />C<br />C<br />R <br />A<br />*Milk & Milk products, blowing of nose<br />DIET<br />Cool clear liquid<br />Ice chips<br />Gelatin<br />Ice pop/Popsicle<br />Fruit sherbet<br />Apple juice<br />itrus, carbonated food<br />rying, coughing,<br />Clearing throat<br />ed/Brown Colored Foods <br />Rough Foods<br />spirin<br />
  31. 31. CHF<br />
  32. 32. <ul><li>Post-op priority: prevent trauma to suture line
  33. 33. Logan’s Bar – to avoid trauma
  34. 34. Elbow restraints</li></li></ul><li>
  35. 35. <ul><li>UP/Dorsal
  36. 36. Down/Ventral
  37. 37. Prone to infection
  38. 38. Less Prone
  39. 39. Cpx: Chordee
  40. 40. Cpx: Extrophy of the Bladder </li></ul>Surgery: <br />Meatotomy<br />Urethroplasy<br />Circumcision – skin graft<br />Intervention: post-op<br />Urinary Diverion /Stent<br />Avoid tub bath until stent remove<br />Asses patency of stent<br />Pain Meds<br />Anti cholinergic – relieve spasm<br />Increase Fluid Intake<br />Follow up check after 4 days<br /> Remember:<br /><ul><li>Do not circumcise right after birth
  41. 41. Surgery before toilet training (2 y.o.)
  42. 42. Asses stream of Urine</li></li></ul><li>
  43. 43.
  45. 45. Kaposis sarcoma<br />
  46. 46. Acute cellulitis<br />
  47. 47. Nasogastric Tube<br />Insertion:<br /> - NEX<br /> - High Fowler’s position<br /> - Sips of water and advance tube as client swallows<br /> - Do not force the tube!<br />Confirm placement of NGT<br />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. <br />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 <br />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<br />Feeding set changed q24h. Bag rinsed q4h.<br />
  48. 48. LMRjuris<br />
  49. 49. Human Motivational Theory<br /><ul><li>Theory A
  50. 50. -American style
  51. 51. - Predominantly downward communication pattern
  52. 52. - Rapid evaluation & promotion
  53. 53. - Segmented concern for employees</li></li></ul><li>Theory X and Theory Y (Douglas Mc Gregor, 1960)<br />
  54. 54. Theory Z (William Ouchi, 1981)<br /><ul><li>- promotes a relationship-oriented, democratic leadership style
  55. 55. - work is natural & a source of satisfaction
  56. 56. Elements:
  57. 57. 1. Collective decision making
  58. 58. 2. Long term employment
  59. 59. 3. Slower but more predictable promotions
  60. 60. 4. Holistic concern for employees</li></li></ul><li>
  61. 61. Social System Model for Hospitals<br />Environment<br />Outputs<br />Inputs<br /> Process Structure<br />People<br />Staff<br />Patients<br />Material<br /><ul><li>Drugs & chemicals
  62. 62. Equipment
  63. 63. Diet</li></ul>Money<br /><ul><li>To maintain staff, facilities & procure materials</li></ul> Communication<br /><ul><li>Between *Upward
  64. 64. Downward *Lateral</li></ul>Decision Making<br />For:<br /><ul><li>Cure, Diagnosis, Treatment
  65. 65. Patient Care
  66. 66. Procurement of materials</li></ul>Action:<br /><ul><li>Putting decisions into practice
  67. 67. Balanced mix of communication,</li></ul> decision making & action<br />STANDARDS<br />EFFICIENT PATIENT CARE<br /><ul><li>Lesser hospital stay
  68. 68. Improve vitals sign
  69. 69. Zero infection & complications</li></ul>Discrepancy between Actual and Expected Performance<br />
  70. 70. Types of Budget<br />a. Open-ended Budget - single cost estimate <br />b. Fixed ceiling Budget - uppermost spending limit<br /> - set by the top executive<br />c. Flexible Budget - set for each level of activity or different operating conditions<br />d. Performance Budget - based on the function and activities of personnel<br />e. Program Budget - program budget cost<br />f. Zero-based Budget - justifies in detail the cost of all programs<br /> - old and new<br />g. Sunset Budget - designed to self destruct within a prescribed period to ensure cessation of the funded program<br />
  71. 71. Managerial Level<br />Top Level manager <br />- organizational decision makers<br /> - commands over the middle manager<br /> - conceptual ability; strategic (long term planning)<br />Middle manager<br />- coordinate nursing activities to several nursing units<br /> - receive broad strategies & policies from to managers<br /> - supervise 1st line managers<br />FirstLevel manager <br />- in-charge of day to day operation<br /> - responsible for non managerial staff<br /> - clinical operation in-charge<br /> e.g. nursing supervisor<br />
  72. 72. Different leadership styles:<br /><ul><li>1. Autocratic
  73. 73. -leaders exert total control over members</li></li></ul><li><ul><li>2.Democratic/
  74. 74. Participative
  75. 75. -leader shares control with group members</li></li></ul><li><ul><li>3. Laissez-faire/
  76. 76. Permissive/
  77. 77. ultraliberal
  78. 78. -leader relinquishes control to group members.</li></li></ul><li>4.Consultative Leadership<br /><ul><li>-focuses on using the skills, experiences, and ideas of others
  79. 79. - leader: retains the final decision-making power (veto power)
  80. 80. - involved others in decision making</li></li></ul><li><ul><li>4. Multi critic/ Situational/ Contingency
  81. 81. -leader utilizes varying styles depending on the situation
  82. 82. - should be complementary to manager’s style, expectations & characteristics of workers
  83. 83. -how to accomplish? “Aligning closely the forces in the manager, worker & situation”</li></li></ul><li>Elements of Bureaucracy<br />Division of labor<br />Hierarchy of authority<br />Impersonality<br />Employment based on technical qualifications<br />Structured written rules & regulation<br />
  84. 84. METHODS OF CARE DELIVERY<br />a. PRIMARY NURSING <br />- total care; 24/7<br /> - sole accountability<br />b. CASE METHOD <br /> - Oldest Method; 1:1<br /> - client centered<br /> - e.g. ICU nurse<br />c. FUNCTIONAL METHOD <br /> - 1nurse 1 task<br /> - task oriented<br />d. TEAM METHOD <br /> - 1 team 1 group of patient<br /> - collaboration oriented<br />* team composition <br />a. RN team leader c. Nursing Aides<br /> b. License Practical nurse<br />e. CASE MANAGEMENT <br /> - management of specific case through out hospitalization<br />* criteria of cases:<br />a. with specific physician c. by diagnosis<br /> b. geographic proximity<br />
  85. 85. Communication steps<br />
  86. 86. Changing people’s behavior<br />
  87. 87. CONFLICT RESOLUTION:<br />Avoidance – reduce tension<br />Accommodation - self sacrifice<br />Collaboration – mutual attention<br />Compromise - both seek acceptable solution<br />Withdrawing – one party is removed<br />Forcing – immediate end but cause unresolved<br />
  88. 88. “MANAGEMENT BY LIBRO”<br />By the book established rules, systematic & analytical<br />“MANAGEMENT BY KAYOD”<br />Hard working, dedication, INTROVERT & formal<br />Content oriented<br />“MANAGEMENT BY UGNAYAN”<br />Situational, integritive, most ideal pinoy manager<br />“MANAGEMENT BY OIDO”<br />By ear, based on practical<br />“MANAGEMENT BY LUSOT”<br />Avoid much work, extrovert, & informal<br />Process oriented<br />
  89. 89. Total Quality Management (TQM)<br /><ul><li>Based on theory Y & Z
  90. 90. Centered on QUALITY
  91. 91. Based on all member participation/involvement
  92. 92. Aim is long term success & improvement
  93. 93. Achieve customer satisfaction</li></li></ul><li>Hypothesis vs Assumption<br />
  94. 94.<br />
  95. 95. CLASSIFICATION OF PERSONS CRIMINALLY LIABLE:<br />ACCOMPLICE:<br />a person who cooperates <br />“ accessory before the fact”- absent at the time crime is committed.<br />Principal:<br />a. By direct participation- doer of the act<br />b. By inducement-directly force or induce others<br />c. By cooperation- indispensable<br />ACCESSORY:<br />“accessory after the fact”<br />a. Profits<br />b. Conceals/ destroys evidence <br />c. Assists in the escape of the principal<br />
  96. 96. Administering Ear Medications<br />Place the client in a side-lying position with the affected ear facing up.<br />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.<br />Instill the drops into the ear canal by holding the dropper at least 1⁄2 inch above the ear canal<br />Ask the client to maintain the position for 2–3 minutes.<br />
  97. 97. Catheterization<br />
  98. 98. Length of catheter insertion<br />male: 6-9 inches<br />female: 3-4 inches<br />
  99. 99. Enema<br />Prepare the solution, assure temperature within range of 99° to 102°F by using a thermometer or placing a few drops on your wrist.<br />Wash hands and don gloves.<br />Assist patient to left side-lying position, with right knee bent.<br />Hang bag of enema solution 12 to 18 inches above anus.<br />Lubricate 4 to 5 inches of catheter tip.<br />Separate buttocks, insert catheter tip into anal opening, slowly advance catheter approximately 4 inches.<br />Slowly infuse solution via gravity flow<br />If client complains of increased pain or cramping, or if fluid is not being retained, stop procedure, wait a few minutes, then restart<br />Clamp tubing when fluid finishes infusing; remove catheter tip.<br />Assist client to bedpan, commode, or toilet;<br />
  100. 100. Enema<br />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.<br />
  101. 101. Transmission Based Precaution<br />
  102. 102. Anaphylactic Reaction<br />acute systemic hypersensitivity reaction that occurs within seconds or minutes after exposure to certain foreign substances<br />
  103. 103. Anaphylactic Reaction<br /><ul><li>Ask the patient about PREVIOUS ALLERGIES
  104. 104. Avoid giving PARENTERAL MEDICATIONS unless absolutely necessary
  105. 105. Perform a SKIN TEST (negative skin test results do not always indicate safety)
  106. 106. Outpatient, keep at least 30 minutes after injection
  107. 107. Wear medical identification tags or bracelets</li></ul>MANAGEMENT<br /><ul><li>airway and ventilation is essential
  108. 108. aqueous epinephrine administered </li></li></ul><li>Anaphylactic Reaction<br />LIMITING EXPOSURE TO STINGING INSECTS<br /><ul><li>Avoid places where stinging insects congregate
  109. 109. Wear adequate covering
  110. 110. Avoid perfumes, scented soaps, and bright colors
  111. 111. Keep car windows closed</li></li></ul><li>Anaphylactic Reaction<br />If stung: <br /><ul><li>Inject self immediately with EPINEPHRINE
  112. 112. Remove the stinger with one quick scrape of the fingernail. (Do not squeeze)
  113. 113. Clean with soapy water, and apply ice.</li>