NUR 280 Essential Concepts (Historical) 2022 Update
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Course
NUR 280
Institution
NUR 280
Maslow
1. Basic Needs- Airway, Resp. Effort, HR, Rhythm, Strength of Contraction, Nutrition, and Elimination
2. Safety/Security- Protect from injury, trust in nurse-client relationship
3. Love/Belonging- Support Systems protect from isolation
4. Self-esteem- control, competence, positive rega...
professional issues leadership amp management of care teaching cultural
• disaster intervention plan
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NUR 280
Essential
Concepts
(Historical) Update
Fall 2015
, Maslow
1. Basic Needs- Airway, Resp. Effort, HR, Rhythm, Strength of Contraction, Nutrition, and Elimination
2. Safety/Security- Protect from injury, trust in nurse-client relationship
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3. Love/Belonging- Support Systems protect from isolation
(AAPIE) Assess (gather data), Analyze (ID problem and formulate diagnosis), Plan (Write care plan to meet goals),
Implement (Carry out plan), Evaluate (Collect data to determine if goals are met)
Avoid ONLY and ALL, EVERY, MUST, NONE, ALWAYS and NEVER in answers
Usually correct if they have : MAY, USUALLY, NORMALLY, COMMONLY,
GENERALLY 5 rights: right pt, med, dose, route, time
PPE: gown, mask, goggles, gloves
Professional Issues / Leadership & Management of Care / Teaching / Cultural
• Primary prevention – education, vaccination, reduce risk factors. Immunizations, counseling about
safety, injury, and disease prevention.
• Secondary prevention – procedures to detect and treat disease thereby controlling disease progression.
Screening tests, anything diagnostic.
• Tertiary prevention – after disease has developed and been treated, tertiary seeks to soften the
impact caused by the disease.
• Palliative care – AKA end of life care. Supportive interventions that focus on control of symptoms. Pain
is priority. Symptom management rather than cure of disease.
• Disaster preparedness –START Simple Triage and Rapid Treatment. Assess RPM: RESPIRATIONS,
PERFUSION and MENTAL STATUS. No RR= BLACK TAG. RR present move down. RR above 30=
RED TAG. RR less than 30, move to perfusion. Absent radial pulse & Cap Refill < 2= RED TAG. Present
pulse and cap refill >3, move onto mental. Altered LOC= RED TAG. Follows commands=YELLOW
TAG. Walking wounded = GREEN TAG.
• Reverse Triage- works on the principle that the greatest good is done for the greatest number of people.
Person who is ambulatory would be triaged first and moved to an area away from the event. Then would be
minor injuries such as a broken leg. Last is the unconscious person with the least chance of surviving.
• Disaster intervention plan – primary prevention. Formal plan of action for coordinating the response of
the health care agency staff in the event of a disaster. Assessment, planning of therapeutic intervention,
implementation of therapeutic intervention and resolution of the crisis. Determine the crisis severity,
assess the clients perception, formulate nursing diagnosis. Level 1 disaster = massive with significant
damage and a presidential disaster declaration. Level 2 disaster = moderate with possible presidential
declaration. Level 3 disaster = minor with minimal damage, president declares emergency.
• Health promotion program (planning) – immunization and prevention of disease….? Considering cultural
issues, assessing pt’s ability to perform self-care, identifying high risk behaviors, providing health
screening and prevention programs, identifying high-risk behaviors.
• Delegation (LPN;UAP; Float RN) – Cannot delegate what you EAT. LPN cannot do IV med, blood,
admission assessment, nursing diagnosis, teaching, complex skills, unstable/acute patients. UAP lowest
level of skill required. Can do feeding, hygiene, basic skills, chronic diseases, ambulation, ROM. Float
RN gets most stable patient. Possibly familiar area of care. RN- Independent pt. assignment. Initial
physical assessment on admission to hospital, unit, or area. Focused assessment with change in patient
condition. Determine patient problems (nursing diagnosis). Document plan for unresolved problems at
discharge. Insert a midline/PICC catheter to withdraw blood or initiate IV fluids. Flush a PICC line, access
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ports, push meds, add meds to IVs, remove a midline or central line, give blood products and manage PCA
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pumps. Trach change, dialysis, verbal orders, hourly chart checks. Don’t delegate what you can EAT.
LPN-
, The experienced LPN is capable of gathering data and making observations, including noting breath sounds
and performing pulse oximetry. May give meds, do dressing changes, suctioning, catheterization and may
review teaching plans the RN has set. Can’t IV push, handle blood or EAT. Delegate stable, chronic pts to
them. UAP- Noninvasive skin care, ADLs, ambulation, grooming, ROM, hygiene, administer enemas,
gather vitals.
• Client teaching (strategies) – Know level of education, cultural beliefs. Return demonstration….? Verbal
and written. Tell them to “show you back.”
• Preventing medication errors – 5 rights. Right patient, med, dose, route, time. Consider
allergies, documentation, and expiration date.
• DNR (family) -- Verbal verification from family does not constitute as a valid DNR. Healthcare
professional must issue and sign the order. A DNR order does not suspend all medical care, but only
instructs that CPR not be performed in the event of cardiac or respiratory arrest. Form must be
present during code in order to honor.
• Cultural diversity (communication) – Language spoken, voice quality, pronunciation, use of silence, use
of nonverbal. African American- Head nodding doesn’t always mean agreement, nonverbal communication
is important, prolonged eye contact may be perceived as rude. Asian- Silence is valued. Eye contact may be
considered rude. Don’t express criticism or disagreement verbally. Hispanic- Verbally expressive. Avoiding
eye contact with authority is s sign of respect. Use dramatic gestures and facial expressions to express
emotions. Native Americans- Silence indicates respect. Eye contact may be disrespectful. Body language is
important. White- Silence can either be for respectful or disrespectful. Eye contact indicates trust.
• Client privacy – HIPAA Pt has the right to withhold information from family.
• Documentation – Objective not subjective. No opinions. If you don’t document, it didn’t happen.
Document frequently. State facts only. Place pt’s statements in quotation marks. DON’T
DOCUMENT THAT YOU DID AN INCIDENT REPORT.
• Conflict Resolution (staff) – Avoidance – postpone issues. Accommodation – Serve others, feel
resentment. Competition – pursue own needs at expense of others. Stand up for rights and principles.
Compromise – work openly and creatively to find a solution.
• End-of-life care – Shifts care from invasive interventions aimed at prolonging life to supportive
interventions that focus on control of symptoms. 6 months before death. Consider organ and tissue
donations, advance directives, legal documents, withholding or withdrawing treatment, and CPR.
Advocate for patient. Encourage to express feelings. Consider cultural rituals, state laws, etc. Jews usually
oppose prolonging life after brain damage. Amish allow organ donation of everything but the heart. Hindus
prefer cremation and no one other than the family can touch the body after death. Asians view dying at
home to be bad luck and generally the family doesn’t tell the pt the diagnosis or prognosis.
• Rapid Response team – Provide nursing staff with internal consultative services provided by expert
clinicians. Early detection and resolution of client problems. Used to assist nurses in the rapid detection
and resolution of pt problems. Made up of ICU nurses, respiratory, lab and EKG.
• Impaired professional – If RN suspects that co-worker is abusing chemicals and potentially
jeopardizing patient safety, the nurse must report to the nursing administration in a confidential manner.
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It’s the responsibility to report to your nurse manager anyone who seems impaired.
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• Establishing rapport aka trust.
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