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33 Cards in this Set
- Front
- Back
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Patient-Controlled Analgesia (PSA) |
- syringe pump contains narcotic agonist (usually morphine) connected to IV pump, IV catheter - patient self-administers small dose of analgesic - pump limits amount and frequency of dose - provide patient/family teaching (ONLY the patient should be hitting the button) - record amount used and degree of pain relief - measure and record respirations |
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Narcotic Agonists-Antagonists |
Actions: - stimulates specific opioid receptors in the CNS - block opioid receptors that may be stimulated by other narcotics Uses: - moderate to severe pain - adjunct to general anesthesia - labor and delivery |
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Narcotic Antagoinst (Naloxone (Narcan)) |
Action: - binds strongly to opioid receptors but does not activate them; blocks the effects of opioids in the system Uses: - reverse respiratory depression, sedation and/or hypotension from narcotic agonists - withdrawal symptoms |
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Antimigraine agents |
-migraines - severe, unilateral, pulsating pain -aura - sensation of sensory/motor disturbances about 30 minutes prior to onset - believed to be related to dilated arteries in the brain leading to hyper-perfusion |
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Ergot derivatives |
Drug of choice for oral route, also available, MI, IV |
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Triptans |
- bind to selective serotonin sites leading to vasoconstriction (more likely used for migraines) |
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Managing Care |
45,000 people die each year because they do not have health insurance 1 in 5 Americans live in areas without adequate access to primary healthcare The Patient Protection and Affordable Care Act (PPACA) provides Medicaid or subsidized coverage for qualifying people |
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Cost-effective care |
Types of payer systems: - pay for performance - multi-payer system - single payer system |
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Pay for performance |
Financial incentives to reward providers in various areas - Healthcare Effectiveness Data and Information Set (HEDIS) - Measures performance in 5 domains of care - Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) --> Medicare - patient satisfaction surveys - 30% of payment is based on these surveys - Re-admissions - penalties for excess re-admissions |
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Multipayer system |
- private insurance companies - Federal government - Medicare - Medicaid - CMS (Centers for Medicare and Medicaid Services) |
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Single payer system |
One entity runs and pays out all healthcare costs (Canada) |
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The American (Healthcare) Dollar |
31% Hospital care 20% Physicians/clinical services 10% Retail - Rx drugs - US has highest cost and lowest quality of life |
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Strategies to reduce costs |
- Quality improvement tools (LEAN SIX SIGMA) - Improving transitions (better hand-offs = better outcomes) - Improve efficiency - Eliminate unnecessary costs (fraud & abuse) - Improving population health - Preventative care (mammograms, physicals, flu vaccines, etc.) |
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Challenges to our healthcare system (SLIDE #11 NOT IN PRESENTATION) |
- Increasing age of population - Changing expectations - Changing technologies - Emphasis on improved quality and safety - Nursing shortage |
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Nurse's role (SLIDE #12 NOT IN PRESENTATION) |
- Protesting health-related problems in our nation - proposing solutions - increasing education - care coordination |
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Care Coordination |
Care coordination: The deliberate organization of patient care activities between 2 or more participants in order to facilitate the appropriate delivery of healthcare services - goal is to meet patient needs and prefererences in the delivery of high-quality, high-value care - must view from multiple perspectives - increased need due to an increase in older adults with more complex needs |
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Managing Care |
- promotes continuity of care - improves hand-offs - improves overall quality of care |
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Special populations |
- disabilities or multiple chronic conditions - mental illness or substance abuse - cultural, racial, and ethnic minorities - rural and urban poor - undocumented immigrants |
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The Care Coordinator |
- requires expertise in self-management and patient advocacy - communicates with a range of people - identifies health goals with both patient and family - Nurse Navigator: a clinically trained nurse who identifies and removes barriers to timely and appropriate treatment; guides the patient through the care continuum - Patient Navigator: includes all models of navigation; typically does not have a clinical background (social workers) (scheduling, financial assistance, psycho-social issues) |
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Delegation |
- Delegation is the transfer of responsibility for the performance of an activity to another person while retaining accountability for the outcome - Delegation is a skill - Unlicensed assistive personnel (UAP) (includes CNAs) - Licensed Practical Nurse (LPN) - "assign" to RT and PT NOT "delegate" |
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Considerations for delegation |
- stability - complexity - potential for harm - predictability - overall context |
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Essentials of delegation |
- state and institutional policies - nursing process (cannot be delegated) vs nursing tasks (can be delegated) - training and background - safety - client needs - be attentive for cues that indicate changes to client condition - evaluate |
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Five rights of delegation |
- right task - right circumstance - right person - right communication - right supervision (read: evaluation) **KNOW THESE** |
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Tips for delgation |
- know what clinical cues the UAP should be alert for and why - have UAP read back instructions - frequent rounding - frequent mini-reports |
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Things you cannot delegate |
- nursing assessment of new/changing problems - nursing judgement - documentation - tasks outside of nursing scope of practice |
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Collaboration |
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Key terms of collaboration |
Confer - consult with someone to exchange ideas, seek information, advice or instructions Consultation - process of inviting another professional to evaluate the patients and make recommendations (brings in) Referral - guiding the patient to another source for assistance (sends out) |
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Interdisciplinary Teams |
- in the acute care setting, these usually consist of: - physician/provider - primary nurse - charge nurse - pharmacy - respiratory therapy - physical therapy - case manager/discharge planner - unlicensed assistive personnel (UAP) Page 159, Box 8-5 |
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Interdisciplinary Communication:Rounding |
- purpose of rounding is to: - gather information - plan nursing care - evaluate nursing care - facilitate patient participation - provide a short summary that includes medical & nursing diagnoses - use language that is easily understood by patient and family |
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Barriers to interdisciplinary communication |
- complexity of care - differences in schedules/professional routines - historical inter/intraprofessional rivalries - personality differences - varying levels of qualifications - emphasis on rapid decision making - disruptive behaviors (aggressive communication) |
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Chain of command |
- a system where authority passes down from the top through a series of positions or ranks in which each individual is responsible to their superior - a line of responsibility for appropriate patient care - goal is to facilitate communication, teamwork, and collaboration - helps to address disruptive behavior |
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ABTech Nursing Chain of COmmand |
1. Person (s) exhibiting the conduct 2. Direct instructor (clinical, lab, or classroom) 3. Lead Instructor (and Clinical Coordinator if the issue is at clinicals) 4. Associate chairperson 5. Chairperson 6. Dean of Allied Health 7. Vice President of Student Services 8. President 9. Board of Trustees |
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Delegating in practice: |
- Your unit staff - 1 floor RN - 1 LPN - 2 CNAs - Your patients - Room 308 - admitted for heart failure (HF). Last VS 12 hours ago. Currently complaining of SHOB. - Room309 - right hip fx with a history of falls. Preparing to be discharged to skilled nursing facility (SNF) tomorrow. Dry dressing change required. - Room310 - admitted last night with COPD exacerbation. VSS (vital signs stable). Complaining of headache 6/10. - Room311 - post-op, just returned from OR after left below the knee amputation (BKA). C/O pain in left leg 9/10. ---------------------------- Delegate. 311 needs to be seen by RN first. Pt has not been assessed by an RN yet, just returned from OR, therefore, the LPN cannot see the pt until the pt has been evaluated by the RN. 308 LPN 309 CNA 310 CNA Patient teaching cannot be delegated to LPN. |
