The primary role of the nurse is:
A) Utilizing technological advances to improve care
B) Assuring that all medications are given correctly
C) Assessment
D) Acting as the communication bridge between all the health care disciplines.
2. an accurate initial assessment is important because it:
A) Establishes the patient’s baseline.
B) Is the primary reference for the pharmacy
C) Shows trends in the patient’s health
D) None of the above
3. The nurse assesses a patient:
A) At the point of initial contact
B) At the conclusion of the shift
C) Whenever performing a task involving the patient
D) All of the above
4. A nurse’s “Sixth sense” refers to the feeling that:
A) It was going to be a bad day
B) Something is not right with a specific patient
C) There will be an unscheduled admission to the unit
D) The supervisor was watching
5. The primary role of the nurse within the health care team is that of:
A) The eyes and ears of the team
B) The person directly responsible for the actions of all the other team members
C) The person directly responsible for all charting
D) The person who must make all calls regarding the patient
6. Why do patients remain in the hospital?
A) Because patients and families don’t know how to provide necessary care
B) So the doctor can watch them closely
C) For nursing care and ongoing nursing assessment
D) Because all the services they need are under one roof.
7. It is good to perform the history portion of the assessment first because it:
A) helps establish rapport and sets the patient at ease
B) Establishes the base right away
C) Saves time because the patient can change into the exam gown while the nurse charts.
D) Frees up more patient examining rooms
8. Talking with a patient regarding something other than his own health, such as a friend’s recent illness—-
A) Is counterproductive because it takes the conversation off on a tangent
B) Can be beneficial because it relates to health concerns the patient has himself
C) should be avoided because it easily degrades to gossip
D) should only be done if there is no other way to get the patient to talk
9. Teaching moments can occur during the history phase of the assessment as a result of
A) questions asked by the patient
B) statements made by the patient
C) input from a family member who the patient has asked to have present
D) all of the above

10. Which of the following statements regarding medications is not true?
A) It is not uncommon, especially among older patients, for a person to be on a number of prescriptions
B) Asking about medications as a group during the history can help the patient remember them better
C) Most patients have a good understanding regarding the effects of their medications
D) It is helpful to give patients a card with all the current medications listed to carry in their wallet

11. A reproductive history should be done on all women:
A) who have children
B) who are married whether they have children or not
C) only if the reason for the assessment is gynecological in nature
D) all women of childbearing age

12. It is important to use the correct size blood pressure cuff because:
A) the wrong size can alter the reading
B) a cuff that is too small may cause bruising
C) It hurts more and patients become uncooperative
D) American Heart Association studies have shown no reasons to be concerned about cuff size

Gordon’s Functional Health Patterns

Marjorie Gordon (1987) proposed functional health patterns as a guide for establishing a comprehensive nursing data base. These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine the following aspects of health and human function:

Health Perception and Health Management. Data collection is focused on the person’s perceived level of health and well-being, and on practices for maintaining health. Habits that may be detrimental to health are also evaluated, including smoking and alcohol or drug use. Actual or potential problems related to safety and health management may be identified as well as needs for modifications in the home or needs for continued care in the home.

Nutrition and Metabolism Assessment is focused on the pattern of food and fluid consumption relative to metabolic need. The adequacy of local nutrient supplies is evaluated. Actual or potential problems related to fluid balance, tissue integrity, and host defenses may be identified as well as problems with the gastrointestinal system.

Elimination. Data collection is focused on excretory patterns (bowel, bladder, skin). Excretory problems such as incontinence, constipation, diarrhea, and urinary retention may be identified.

Activity and Exercise. Assessment is focused on the activities of daily living requiring energy expenditure, including self-care activities, exercise, and leisure activities. The status of major body systems involved with activity and exercise is evaluated, including the respiratory, cardiovascular, and musculoskeletal systems.

Cognition and Perception. Assessment is focused on the ability to comprehend and use information and on the sensory functions. Data pertaining to neurologic functions are collected to aid this process. Sensory experiences such as pain and altered sensory input may be identified and further evaluated.

Sleep and Rest. Assessment is focused on the person’s sleep, rest, and relaxation practices. Dysfunctional sleep patterns, fatigue, and responses to sleep deprivation may be identified.

Self-Perception and Self-Concept. Assessment is focused on the person’s attitudes toward self, including identity, body image, and sense of self-worth. The person’s level of self-esteem and response to threats to his or her self-concept may be identified.

Roles and Relationships. Assessment is focused on the person’s roles in the world and relationships with others. Satisfaction with roles, role strain, or dysfunctional relationships may be further evaluated.

Sexuality and Reproduction. Assessment is focused on the person’s satisfaction or dissatisfaction with sexuality patterns and reproductive functions. Concerns with sexuality may he identified.

Coping and Stress Tolerance. Assessment is focused on the person’s perception of stress and on his or her coping strategies Support systems are evaluated, and symptoms of stress are noted. The effectiveness of a person’s coping strategies in terms of stress tolerance may be further evaluated.

Values and Belief. Assessment is focused on the person’s values and beliefs (including spiritual beliefs), or on the goals that guide his or her choices or decisions.

Nursing diagnoses are the second step in the nursing process, following assessment. After all the available data is evaluated, the nurse writes one or more diagnoses that identify existing or potential health problems. When a patient has more than one diagnosis, the nurse must decide which problem or possible threat is most important. Priority concerns are those that will either halt or hinder progress or will negatively affect the overall functioning of the patient.

Vital Functions
1. Rule number one: if it can kill or further deteriorate the condition of the patient, it is a priority diagnosis. Everyone needs to breathe and have a heartbeat to survive. Ineffective airway clearance is a priority diagnosis because it hinders the patient’s ability to breathe. Decreased cardiac output is also a high priority because it means an insufficient amount of blood is being pumped through the body to support the metabolic needs. Elderly patients are especially at risk for decreased cardiac output because their heart ventricles are less compliant.
Safety
2. Ensuring the safety of the patient is another top priority. There are many safety concerns to evaluate. A patient experiencing dizziness is at a risk for falls and should be monitored when ambulating. Impaired skin integrity can lead to bed sores, which can lead to infection. These issues need to be addressed before a self-hygiene deficit or deficient knowledge diagnosis. It is highly unlikely that not taking a bath can injure or kill a patient. However, falling while walking to the bathroom or acquiring an infection can.
Pain
3. Pain affects the entire body. It can increase heart rate and blood pressure, alter mood and cause stress and anxiety. Until the pain is managed, it will be difficult to proceed with other lower priority nursing interventions. For example, a patient recently had knee surgery and is cleared to start ambulating. He is also being discharged soon and needs to understand care instructions. But his knee is still causing him a great deal of pain. He is not interested in trying to walk, he doesn’t want to hear his instructions, he just wants to stop hurting. Everything else comes to a halt until that pain reaches a manageable level.
Actual vs. Risk
4. In nursing, there are actual and risk diagnoses. An actual diagnosis means the health concern is already present. A risk diagnosis means the nurse has reason to believe the concern is imminent. Generally speaking, the actual problem should take priority over the risk, unless the risk can cause injury or death. In some cases, taking care of the actual concern can decrease the likelihood of the risk. For example, anxiety takes precedence over risk for impaired parent/infant/child attachment if the anxiety is the root of the risk. However, a risk for suicide takes priority over constipation because the imminent threat will cause more harm than the present problem.
Considerations
5. Every patient and situation is unique and needs to be evaluated from that perspective. When creating a care plan, look at the diagnoses and determine which health concerns can cause the most damage. If it can cause injury or death, it needs to be addressed first. If it can hinder further goals, it needs to come first. If it can prevent additional problems, it is a priority. There may be cases where there are no major problems or risks. In those cases, prioritize based on what will help the patient reach her fullest health potential.

Establishing priorities is the process of determining a preferential sequencing of activities. Because the nurse is responsible for a large number of activities in the course of a day, she/he needs to write down the priorities.

I. Classifications:

• High, moderate, or low.
• Urgent and important, important but not urgent, urgent but not important, busy work or wasted time.

The nurse needs to have a rationale for priority setting and must use knowledge of the biological and behavioral sciences in deciding how activities will be prioritized.

Two theories most commonly utilized are
—Maslow’s Hierarchy of Needs, which centers on five needs: physiological, safety, belonging, esteem, and selfactualization. Needs are organized hierarchically and the focus is on meeting lower-level needs before higher level needs can be met.
—Levine’s Conservation Principles, which stresses four components necessary for a meaningful existence: conservation of energy, structural integrity, personal integrity, and social integrity.

Factors Affecting Priority Setting

• Time management: When time is managed effectively, the level of productivity will increase. Knowing how long an activity will take will influence the planning process.
• Policies and procedures: Provide a framework for the nurse to know what to do in a given situation.
• Experience: Past experiences of the nurse will influence the way she/he sets priorities.
• Patient preferences: Patient’s likes and dislikes, as well as wishes, can influence priority setting.

[scribd id=16728273 key=key-23n9ashgwxvzp3wgi2fo mode=list]

http://www.scribd.com/full/16728273?access_key=key-23n9ashgwxvzp3wgi2fo

Ok alot of people are afraid of math and if you are one of them, fear not! we are here to help you through this jorney of becoming a member of the health care field.

There are several methods to calcuate dosages, one way is proportion and other way is formula!… i will show you the formula way and i think if you use it you will be victorious!!!

SAMPLE:

SUPPOSE YOU HAD A MEDICATION WITH A DOSAGE STRENGTH OF 50 MG PER ML, AND THE PRESCRIBER ORDERS A DOSAGE OF 25 MG.

forumla is:

Doctors order (D) DEVIDED BY THE AMOUNT ON HAND (H) X  by the quantity….

d/h x q =

Doctor order in this case is 25 mg /ml / 50MG/ml (Dosage on hand) x quantity. (1)

25/50 = .5 x1 = 0.5 Ml

USEFUL LINK

Conversion Factors for Nursing Students

Now here a twist:

Order is 400mg p.0 of liquid medication

available is 125mg per 5 ml

We have heard of errors made in filling prescriptions because of the difficulty pharmacists have in reading the physician’s handwriting, or because certain drugs have similar names. This should alert all of us to check and understand what is written on your doctor’s prescription before giving it to the pharmacist. Remember to ask the physician about any questions that you may have about the prescription he is giving you. In order to help our readers decipher their prescription we are presenting a table of common terms found on a prescription and their meaning.

Ok we all know that the health care system is takinga hit right now and there is a lot of lobbying going on in washigton to change and take care of the mess that healthcare is currently in. We will go through a few things that i think you should be aware of when it comes to healthcare and its delivery system.

First we need to get a comprehensive undersatanding of the healthcare system and what each part of the system does. There are many systems currently in place to address various diverse issues that are facing the healthcare system. Currently the insurance companies are the biggest winner when it comes to healthcare, and current lobbying is trying to but a stop to that which President Obama calls a waste in spending. If you are taking Nursing 130 or begining nursing course, and is using the perry and potter book to study, chances are you would want to use this for your review and understanding of your reading. They have a review book that comes with your textbook, which i think is the best way to study.

These formats are taken from the perry and potter book and i will define and answer questions asked on the review questions. This should not be a substitute for your required reading but will help you in digesting your material and master the material. If you are able to answer these questions it will basically prove to yourself that you have master the material.

When we here the word prospective payment system what does this mean? Well first it eliminate cost based reimbursements.. A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services). CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. (http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/)

Vocabulary:

Prospective payment system: Eliminated the cost-based reimbursements.

Diagnosis-Related Groups: also knows as DRGS: Hospital receives a set dollar amount based on an assigned group.

Capitulation: Provider received a fixed amount per client.

Resource Utilization Groups: Utilized Long-term care

Managed Care: the organization assumes financial risk in addition to providing client care

independent pracitce association (IPA) – FEE FOR SERVICE and capitated clients

Medicare: Federally funded program for people 65 years or older

Medicaid: Federally funded state operated health insurance for low income families.

Now lets talk a little bit about level of health care. Now let define the difference between Primary health care and primary care.

Primary care basically focuses on health services provided on an individual basis while Primary Health care focuses on the health services to a population.

Secondary and Tertiary Care (Acute Care)

Because of Work Design more services are available on nursing nits, thus minimizing the need to transferclinets across multiple areas. In an attempt to contant cost, hostpital utilized this model (CASE MANAGEMENT) which focuses particually on discharge planning.

Explain the role of nurse in the aove model discharging planning

Comprehensive Understanding:

Domain Of Nursing:

Domain: The domain is the perspective of a profession. It provides the subjes central concepts, values and beliefs. The domain of Nursing provides the theoriticaL and practical aspect for decipline. Including nrusing history, theory,eduaton,. practice, ad research. it provides mean to identify and treat clients health care neds at all level of health care settigns.

Paradigm: A paradigm links science, philosophy and theories accepted and applied by te discipline. It is useful for describing the the domain for a discipline.

Nursing paradigm: includes four linkage, the person, HEALTH, ENVIONMENT, AND NURSING.

person: Recipent of nursing care

environment: All possible condition affecting the client and the settings of health care delivery.

nursing: is the diagnosis and treatment of human response to actual or potential health problems

Theory

7, Nursing theories: is the conceptulization of some aspect od nurisng ccommunicated for thepurpose of describing, explaining, predicting and or prescriing nuring care

8. Theory: Address specific phenomena and reflect pracice. A theory is a set of concepts, definitions and asumptions or proposiions to expalan a phenemenon.

9: phenomenon: is an aspect of reality that people consciously sense or experience. example include caring, slef-care, and client response to stress.

10: concepts: Ideas or mental images. Concepts help to describe or label a phenomenau.

11: definitions: A definition within a theory communicate the general meaning of the concepts. These definition describe the activity necessary to measure the concepts, relationship or variable within a theory.

12: Assumptions: are the taken for granted statements that explain the nature f the concepts, definition purose relatinship and struture of the theory.

13: Grand Theories:

14: Middle-range theories: address specific phenomenon and reflect practice

15: Descriptive theories: describe, speculate and describe consequences of phenomena.

16: Prescriptive theories: action oriented and test the validity and predicatability

Interdisciplinary theories:

17: Give an example of an interdisciplianary theory: Pigets theory of cognitive development help explain how children thinks,

Interdisciplinary theories:

17: Give an example of an interdisciplianary theory: Pigets theory of cognitive development in children. it help explain how children think, react and perceive the world.

18: Give an example of a system theory; Client with impared motility have common skin cancer and need intervention, hygene and schedule positioning changes.)

19: List the five levels of maslows hierachy of human needs:

a) Basic needs such as air water and food.

b) safety and security needs (physical and social security

c) Love and belogning needs

d) esteem and self esteem needs

e) self actulization, ability to solve problems…

Selected Nursing Theories

20: Nightingales: Manipulating the environment to help in healing, environment was the focus of nursing care

21: peplau’s : Nurse and Client relationship

22: hendersons: We all have 14 basic needs

23: rogers : Unitary Man, we all co-exist

24: orem’s – Slef care (teach client to care for themseleves)

25: Leiningers: Transcultural

26: ROYS’: Adptation, teaching client to adapt to enviorment and new situation.

27: watsons: Caring (transpersonal caring)

28: Brennrs and wrubles: Caring also but personal concern as an inherent feature of nursing practice.

29. Which of the following conceptual models veiws the person and the enviroment as energy field coexisting with the universe?

1. roy’s adaptation model

2. orems model of the self care

3. kings model of persal interpersoal and social systems

4. rogers life process interactive person environemntal model.