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How would you prioritize maslows hierarchy of human needs?
- Assessment-assist RN collect obj/subj data.
- Diagnosis- nursing diagnosis/NANDA.
- Planning-developing outcome (plan) to meet pt needs.
- Implementation-(action) carrying out plan.
- evaluation-revise/check outcome.
PES 3 parts of diagnosis.
- Problem-nursing dx/NANDA list.
- Etiology-(cause) R/T
- Signs/symptoms-subj/obj data, valid diagnosis(AEB).
WHATS UP? guide to symptom/assessment for pain
- W-where is it?
- H-how does it feel? describe quality.
- A-aggravating and alleviating factors. what makes it worse or better?
- T-timing. When did it start? For how long?
- S-severity. How bad is it? Scale 0-10.
- U-useful other data. What other symptoms?
- P-patients perception of problem. Idea of problem or cause.
Nurse/dr/and health team work together to reach a desired outcome.
maslow hierarchy of human needs
- least-most important
- self actualization-self-fulfillment/self goal.
- self-esteem/esteem of others-self respect & respect of others. works to achieve success, and recognized in work,desired prestige(admired) from accomplishments.
- love/belonging-giving and recieving effection, compashion,satisfactory interpersonal relationships.
- safety/security-avoiding harm, maintaining comfort, order, structure, physical safety, freedom from fear, protection.
- physicological needs-basic fundamental needs, food,water, air, exercise,shelter, sex.
- patients desired goal for a problem area.
- To achieve outcome must be measurable,realistic,and time frame.
- should not be vague or open to interpretation,with the use of subjective words such as: normal, large, small, moderate.
- example-pt short of breath will improve.
- pt will be less short of breath within 15mins AEB pt breath scale 0-10.
prioritizing care maslow
- 1-ineffective airway/physiological need can be health threatening
- 2-constipation/physiological need can be health threatening
- 3-deficient knowledge/safety and security
- 4-disabled family coping/love and belong
- 5-readiness for enhanced self concept/self esteem needs
purpose of nursing process
achieving optimal health.
HEART ATTACK r/t INEFFECTIVE TISSUE PERFUSION.
nurse evaluates the pt progress toward the desired outcome and the effectiveness of each intervention.
- ask the burning question
- search for most relevant best evidence available.
- think critically
- measure outcome before/after change.
- make it happen
- evaluate the practice change.
EBP-quality and safety belong together.
- insurance companies, businesses, patients and government are demanding quality care.
- EBP framework-quality initiatives(to begin a task) require collection of data.
- all quality initiatives should begin with a literature search to determine the most effective interventions.
tube feeding preparing to give oral care.
use a soft toothbrush and fluoride toothpaste to brush the teeth.
- autocratic leadership-100%high degree of control. no control to others. determines goals and plans to achieve goals. no input by others. used for emergency/fast desicion.
- democratic leadership-50/50%moderate degree of control, others are given some control and freedom, participation is encouraged,high quality outcomes.
- laissez-faire leadership-0/0%no control over group, others have complete freedom, no one responsible for goal, poor outcome.
- coaching leadership-active listening, clear communication, coaching leader works with others to develop problem solving skills(critical thinking, prioritize, effective communication) helps direct employees feel more empowered valued and respected.
initial direction for the task and then monitoring of the task and outcomes at intervals.
empowering another to action.
- Right task-is it appropreate to delagate?
- Right circumstances-is this situation safe and appropriate for delegating?
- Right person-appropriate person for task ?
- Right communication-is there clear understanding between you & delegatee of terms and reporting needs?
- Right supervision-is it defined how and when direct supervision will occur?
- obligation to be faithful to commitments made to self and others.
- not promising something you cant keep. R/T confidentiality.
nurse can have a ethical dilemma when a hospital policy on staffing creates a situation that does not allow nurses to provide the quality of care they feel is needed.
- doing no harm.
- R/T beneficence and is opposite side of coin.
- not telling truth because may cause more harm. protect from harm those who are vulnerable.
practical wisdom or common sense.
laws guarantee some rights, other moral rights such as based on values and ethical principles but are not enforced by law. "basic human rights"
right of self determination,independence and freedom founded on the notion that humans have value, worth and moral dignity.
- principle of considering and offering treatments and care options that are likely to provide benefit to the pt.
- prevent harm.
- principles of fairness ans equality.
- equal treatment.
scope of practice
- state nurse practice laws and the attendant nursing regulations establish the parameters within which nurses must practice to obtain and maintain state license.
- these regulations are refers to administrative laws.(scope of practice).
Health Insurance Portability and Accountability Act.
level of responsibility that society places on individuals for their actions.
rules of social behavior/action taken by a person against society.
dicate how disputes are settled among individuals and how liability is assigned for wrongful actions.
a civil liability suit
- begins with filing a complaint with the court.
- next is summons to court.
lawsuits involving civil wrong.
- breach of duty' didn't purposely do anything wrong. Improper or negligent treatment of a patient, as by a physician, resulting in injury, damage.
- accused of intentionally causing injury.
- assault-treats fear
- unintentional tort.
- injury results from the failure of wrongdoer to exercise care.carelessness
- didn't do the care right.
limitation of liability
- ways to limit liability include ensuring pt rights, accurately documenting procedures, following institutional policies, acquiring individual malpractice or liability insurance, pursuing continuing education, and practicing in accordance with the current standards of the nursing profession.
- do all your wk.
welfare rights (legal rights)
inforced by law. legal entitlement to some good of benefits. guaranteed by law bill of rights.
culture beliefs and religion come from?
family, community. is not inherited.
the tendency for humans to think that their ways of thinking acting and believing are the only right way/natural way.
something a person excepts as true. religion
standards that has meaning or worth.
- Monitor take assessment
- Action treat problem
- Teach patient
Internal dysfunction with unknown cause.
- is creating ethical dilemmas.
- prolongs life.
- moral problem is by stopping ventilation.
- hands on moving energy.
keep clock in front of them.
- females don't look in eyes.
- don't shake hands, bow.
don't talk loud to them and don't touch.
self accumulation of maslow
reach level fall potential
complementary or alternative whats the difference?
- complementary therapy-therapy used in addition to a conventional therapy.
- example-guided imagery, music and relaxation techniques for pain control.
- alternative therapy sometimes called "unconventional" therapy, refers to a therapy used instead of conventional or main stream therapy.
- example-acupuncture instead of analgesics.
primary system of medicine
- is just called medicine in US.
- or some ppl refer it as allopathic medicine(western medicine).
most common is western meds.
- ancient hindu system of medicine which origanated in india.
- ayurvedic medicine main goal are to maintain the health of healthy ppl and cure the illness of sick ppl.
- ayurveda maintains that illness is the result of falling out of balance with nature.
- diagnoses is based on 3 metabolic body typed called dosha (vata pitta kapha). diet herbal remedies yoga detox.
- techniques is acupuncture(needles along meridians pathway were QI flows) and chi gong.
- diagnosis and treatment of disturbances of QI GONG or vital energy, are distinctive characteristics of Chinese meds.
- normal pathway.
- check health static by checking tongue pulse, face color,assess voice.
- based on belief that illness is result of nerve dysfunction.
- treatment-manual adjustment and manipulation of vertebral column and limbs.
- no surgery no drugs.
- based on Hahenemanns principle that " like cures like" meaning that tiny doses of a substance that creates the symptoms of disease in a healthy person will relieve those symptoms in a sick person.
- not in US.
- natural therapy.
- nutrition, botanical meds(herbs), hydrotherapy(water), counseling, physical meds, homeopathy.
herbs can aid in healing and cause harm.
- a herb used for cold and flu.
for tenderness and pain of osteoarthritis, fibromyalgia, diabetic neuropathy, and shingles.
st johns warts
- for mild to moderate depression; viral infections, including HIV,and herpes.
- Digxon for depression.
- tensing and relaxing muscles. toes-head
- reduce stress and tension.
- used for stress insomnia and BP.
- another example of a complementary therapy that nurses use. mental images to promote physical healing and change attitude and behavior.
- common guided imagery technique begins with a general relaxation process.(relax muscles) use all senses.
- Assume a comfortable position in a quiet enviroment,
- close your eyes and keep them closed until exercise is complete.
- breath in and out deeply to the count of four, reacting this step four times.
- when relaxed think of a favorite peaceful place and prepare to take an imaginary journey there.
- picture what this place looks like and how comfortable you feel being there.
- listen to all the sounds, feel the gentle, clean air, and smell the pleaset aroma.
- continue to breath deeply, and appreciate the feeling of being in this special place.
- feel the sense of deep relaxation and peace of this place.
- as you continue to breath deeply, slowly and gently bring your consciousness back to the settings in this room.
- slowly and gently open your eyes stretch and think about how relaxed you feel.
- 3rd tier of learning progressive relaxation.
- used for asthma, migraine, insomnia bP
- monitor and control tiny metabolic changes in ones body with the aide of sensitive machines that provide feedback.
Progressive muscle relaxation, guided imagery, biofeedback.
Pressure friction kneading of the body.
- warmAswarm tub water.
- releases endorphins.
Heat and cold packs
- A warm compression can soothe sore muscles and dilates vessels in a defined area, bringing healing circulation as well as endorphin release.
- cold numbs area, clause over dilated vessels to constrict.
- no more than 20mins.
Research base intervention.
Become adept at collecting and reporting data related to pt use of complementary or alternative modalities.
Medicine emphasize on interrelationship of the body nerves bones organs.
Complementary and alternative modalities.
- Biological base modalities-herbal natural nutation supplements.
- mind body modalities-art dance guided imagery hypnosis music prayer QI.
- manipulative and body base modalities-acupuncture chiropathic, massage and osteopathic.
- energetice modalities-biofeedback, healing touch,magnet therapy, polarity therapy, reiki, spiritual healing, therapeutic touch.
- misc therapy-aqua therapy/hydrotherapy.