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- 1. Physical integrity
- 2. Affiliative need
- 3. Activity and Rest
- 4. Ingestive need
- 5. Excretory need
- 6. 02-CO2
- 7. Sexual need
Definition of Nursing
- ANA (American Nursing Association)
- Nursing is the protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in the care of individuals, families, communities and populations.
Delegation: What can be delegated to the CNA?
- Basic client care
- assisting with feeding
- collecting specimens
- VS (not apical pulse)
- perineal care
- foot care (except diabetic pt)
- oral care (except unconscious pt)
- condom cath
- oral suctioning using a Yankauer suction tube
California Nursing Practice Act
- 1. Basic health care that help people cope with difficulties in daily living and that require a substantial amount of scientific knowledge or technical skill.
- 2. Direct and indirect pt care that ensures safety, comfort, personal hygiene, and protection of pts.
- 3. Performance of disease prevention and restorative measures.
- 4. Administration of meds. and therapeutic agents.
- 5. Skin test, immunizations, blood draw from veins and arteries.
- 6. Observation of signs and symptoms, determine if they are abnormal, implement procedures.
- 7. May dispense drugs or devices upon an order by a licensed physician
- 8. No clinic shall employ a RN to perform dispensing duties exclusevely. No RN shall dispense drugs in a pharmacy, keep a pharmacy, open shop, or drugstore for the retailing of drugs or poisons.
- 9. Not allowed to compound drugs
- *Nursing diagnosis
- *care plans
- *perform skills and teach clients and families
- *delegate task
- *evaluates the effectiveness of the care plan
- *acts as the client's advocate
- Part A:
- Available for people over 65 or with disabilities. It provides insurance toward hospitalization, home care, and hospice care.
- Part B:
- Voluntary and provides partial coverage of outpatient and physician services to people eligible for Part A.
- Part D:
- Voluntary prescription drug plan
- *Most clients pay a monthly premium for Part B and D
- *Medicare does not cover dental care, dentures, eyeglasses, hearing aids, or examinations to prescribe and fit hearing aids.
- *Most preventive care, including routine physicals and associated diagnostic test are not included. However mammograms are fully cover for women over 40.
- *All medicare clients pay a deductible and coinsurance (usually 20%)
- Federal public assistance program paid out of general taxes to people who require financial assistance such as people with low incomes.
- *Each state program is distinct
Supplemental Security Income
- Persons with disabilities or those who are blind.
- *Also available for people who are not elegible for social security
- -Payments are not restricted to health care cost, clients use this money to purchase medicines or to cover cost of extended health care.
Children's Health Insuranace Program (CHIP)
- Insurance coverage for poor and working-class children.
- -coverage includes visits to primary health care providers, prescription meds, and hospitalization
Women, Infants and Children (WIC)
Provides nutritious foods to supplement diets, information on healthy eating, and referrals to health care for mothers and children up to age 5.
Prospective Payment System
This legislation limits the amount paid to hospitals that are reimbursed by Medicare. Reimbursement is made according to a classification system known as diagnosis related groups (DRG).
- -The hospital is paid a predetermined amount fro clients with a specific diagnosis.
- -In an effort to decrease cost and encourage attention to preventable conditions. Hospitals will no longer receive additional payment for cases in which one of several identified preventable conditions was not present on admission.
- ex: Pressure ulcers and "never events" (objects accidentally left in the body during surgery or incorrect blood type transfusion)
They pay either the entire bill or more often 80% of the cost. The insurance company reimburses the health care provider a fee for each service provided (fee-for-service).
*third party reimburstment: the insurance pays the client's (first party) bill to the provider (second party).
*The individual pays a monthly premium
Health Maintance Organization (HMO)
HMO plan emphasizes client wellness. Health promotion and illness prevention
- Members choose PCP
- Referral needed to see specialty doctors. Plan will not pay for services if referral was not submitted.
Preferred Provider Organizations (PPO)
- Health services at a discounted rate.
- It provides clients with a choice of health care providers and services.
- More expensive than HMO plans.
Preferred Provider Arrangements (PPA)
Similar to PPOs. The main difference is that PPAs can be contracted with individual health care providers, whereas PPOs involve an organization of health care providers.
- Limited or unlimited
- Limited: client can only use the preferred providers
- Unlimited: Client can use any health care provider that accepts the plan.
Indipendent Practice Association (IPA)
Clients pay a fixed prospective payment to the IPA and the IPA pays the provider.
Physician/Hospital Organizations (PHO)
Joint ventures between a group of private practice physicians and a hospital.
A/V Shunt or Fistula
Provides access to artery and vein for pt. receiving hemodialysis.
Assess for patency by checking bruit and thrill
If shunt or fistula is not patent call MD right away
*Bruit: A blowing or swishing sound created by turbulence of blood flow due either to a narrow arterial lumen or to a condition such as anemia or hyperthyroidism that elevates cardiac output.
*Thrill: A vibrating sensation like the purring of a cat or water running through a hose. It too indicates turbulent blood flow due to arterial obstruction.
- Bruit: Auscultate over graft to hear the flow of blood
- Thrill: Palpate over graft to feel flow of blood.
Four techniques of physical assessment
1. Inspection: Sense of sight.
Visual examination with naked eye or lighted instrument (otoscope). Should be deliberated, purposeful and systematic. Olfactory
(smell) and audiotory
cues are noted. Assess moisture, color, texture of body surface, shape, position, size, color and symmetry of the body. Compare findings to opposite site.
- 2. Palpation: Sense of touch. Use the pads of the fingers. Palpation is used to determine texture, temp, vibration, position, size, consistency and mobility of organs or masses, distension, pulsation, tenderness or pain.
- *temperature best with dorsum (back) of the hand and fingers. Areas of tenderness should be palpated last. Deep palpation not indicated for acute abdominal pain or pain that is not yet diagnosed.
- 3. Percussion: Sense of hearing. The act of striking the body surface to elicit sounds that can be heard or vibrations that can be felt. Used to evaluate size, borders, discover fluids in cavities. Evaluate density of underlying structures.
- Direct: Striking the area directly with the pads of the fingers. Useful for adult's sinuses
- Indirect: Striking an object held against the body to be examined.
- 4. Auscultation: Sense of hearing. Listening to sounds produced within the body.
- Direct: use of the unaided ear (respiratory wheezing)
- Indirect: the use of stethoscope
Assessment of the abdomen