ratinalization of peak post test funda and lmr last sept 2 by randel dalauta

1. RANDEL DALAUTA,RN

5. Doctrine of Respondeat Superior “master servant rule” *liability: a. agent/employee – direct liability b. principal/employer – vicarious liability *criteria: a. establish the employee/employer relationship b. act must be committed as harm is done to the patient c. act must be committed with in the scope of employment Doctrine of Res ipsaLouitur “things speak for itself” 3 conditions: a. injury does not normally occur unless there was negligence b. injury caused by an agent with in the control of the defendant c. plaintiff did not engage in any manner that would tend to bring about the injury

6. Captain of the Ship Doctrine “command responsibility” Force Majeure “superior force/irresistible force/ Act of God;fortuitous event” *liability: - free both parties from liability or obligation when extraordinary event or circumstances beyond the control of the parties - defendant must have nothing to do with the events happening *elements: a. Externality – defendant must have nothing to do with the event b. Unpredictability – if event could be forseen, the defendant is obliged to have prepared it. c. Irresistibility – consequences of the event must have been unpreventable. *not answerable unless a. Specified by Law b. Obligation require assumption of risk c. Stipulation

7. TORTS ASSAULT BATTERY FALSE IMPRISONMENT OR ILLEGAL DETENTION

8. Sec.4.The Rights of Patients (4) Right to Information In the course of his/her treatment and hospital care, the patient or his/her legal guardian has a right to be informed of the result of the evaluation of the nature and extent of his/her disease, any other additional or further contemplated medical treatment on surgical procedure or procedures, including any other additional medicines to be administered and their generic counterpart including the possible complications and other pertinent facts, statistics or studies, regarding his/her illness, any change in the plan of care before the change is made

9. Informed Consent “An informed consent is an autonomous authorization by individuals of a medical intervention or of involvement in research” Element: the nature of the decision/procedure reasonable alternatives to the proposed intervention the relevant risks, benefits, and uncertainties related to each alternative assessment of patient understanding the acceptance of the intervention by the patient *patient must be competent & consent voluntarily given *competence should be determined by professionals, approved by the court under the law.

10. When medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information.

11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.

13. METHODS OF CARE DELIVERY a. PRIMARY NURSING - total care; 24/7 - sole accountability b. CASE METHOD - Oldest Method; 1:1 - client centered - e.g. ICU nurse c. FUNCTIONAL METHOD - 1nurse 1 task - task oriented d. TEAM METHOD - 1 team 1 group of patient - collaboration oriented * team composition a. RN team leader c. Nursing Aides b. License Practical nurse e. CASE MANAGEMENT - management of specific case through out hospitalization * criteria of cases: a. with specific physician c. by diagnosis b. geographic proximity

14. Readiness to Learn Types a. Physical Readiness (Skills) - focus away from physical status - anything that using up energy and time b. Emotional readiness (Attitude) - ready/asking about self care activities - not ready: extremely anxious, depressed, & grieving c. Cognitive(Knowledge) - asking about the disease process - cause & details Remember: client is ready if; - Ask questions - Search information -Knowingly shows interest client is not ready if; - Lack of attention - Avoid subjects when brought up - Missed appointments - Express disinterest Nurse Role: Providing physical & emotional support Providing opportunities to learn

15. How to Increase Motivation Relating the learning to values Encouraging self direction & independence Assisting client identify benefits of changing behavior Create learning situation which likely for success (small/easy task) Helping make learning pleasant & nonthreatening (+) - reinforcement - attitude demonstrated by the nurse

16. maslow's hierarchy of needs

17. Communication the exchange of thoughts, feelings, and other information

18. Evidence of Mental health Basic needs meet Effective Coping Skills Emotional stability Satisfying relationship + self concept

20. Using An Extinguisher Pullthe Pin on the extinguisher Aimthe nozzle of the extinguisher at the base of the fire Squeezethe trigger Swipethe nozzle sideways

21. DIFFERENT Precautions

22. Simple Formula IVF C to F :Centigrade x 1.8 + 32 = F Temp F to C: Fahrenheit – 32 / 1.8 = C Desired Available Meds Quantity

23. Enema

24. Enema

25. Miller-abott tube

26. Subcutaneous emphysema

28. OBJECT PERMANENCE – realization that something out of sight still exist, occurs in the later stages of sensorimotor stage development. EGOCENTRIC SPEECH – occurs when the child talks just for fun and cannot see another point of view. ANIMISM– all inanimate objects are given living meaning GLOBAL ORGANIZATION – means that if any part of an object or situation changes, the whole thing has changed.

29. Cerebral Palsy Rhizotomy - locate and cut dorsal root of the nerve that provide over stimulation to specific parts of the body Aspiration precaution - thickened feeding - add rice to the food Drugs - Methocarbamol (Robaxin) muscle relaxant - Baclofen (Lioresal) treat spacity(palambotngkatawan)

30. TONSILECTOMY AVOID C C R A *Milk & Milk products, blowing of nose DIET Cool clear liquid Ice chips Gelatin Ice pop/Popsicle Fruit sherbet Apple juice itrus, carbonated food rying, coughing, Clearing throat ed/Brown Colored Foods Rough Foods spirin

31. CHF

33. Logan’s Bar – to avoid trauma

36. Down/Ventral

37. Prone to infection

38. Less Prone

39. Cpx: Chordee

41. Surgery before toilet training (2 y.o.)

44. USE OF PROTECTIVE EQUIPMENT

45. Kaposis sarcoma

46. Acute cellulitis

47. Nasogastric Tube Insertion: - NEX - High Fowler’s position - Sips of water and advance tube as client swallows - Do not force the tube! Confirm placement of NGT Monitor and record residual volume q4h by aspirating stomach content with a syringe. A residual volume of >100-150 ml indicates delayed gastric emptying. Notify MD. During and after feeding keep HOB 30 degrees to prevent aspiration; For continuous feedings, keep the patient in a semi-Fowler’s position at all times Flush/Irrigate tube feeding with 30-60ml of water q4h during continuous feeding, before and after each intermittent feeding, before and after administering meds, after each time you check residual volume Feeding set changed q24h. Bag rinsed q4h.

48. LMRjuris

50. -American style

51. - Predominantly downward communication pattern

52. - Rapid evaluation & promotion

55. - work is natural & a source of satisfaction

56. Elements:

57. 1. Collective decision making

58. 2. Long term employment

59. 3. Slower but more predictable promotions

62. Equipment

65. Patient Care

68. Improve vitals sign

69. Zero infection & complicationsDiscrepancy between Actual and Expected Performance

70. Types of Budget a. Open-ended Budget - single cost estimate b. Fixed ceiling Budget - uppermost spending limit - set by the top executive c. Flexible Budget - set for each level of activity or different operating conditions d. Performance Budget - based on the function and activities of personnel e. Program Budget - program budget cost f. Zero-based Budget - justifies in detail the cost of all programs - old and new g. Sunset Budget - designed to self destruct within a prescribed period to ensure cessation of the funded program

71. Managerial Level Top Level manager - organizational decision makers - commands over the middle manager - conceptual ability; strategic (long term planning) Middle manager - coordinate nursing activities to several nursing units - receive broad strategies & policies from to managers - supervise 1st line managers FirstLevel manager - in-charge of day to day operation - responsible for non managerial staff - clinical operation in-charge e.g. nursing supervisor

74. Participative

76. Permissive/

77. ultraliberal

79. - leader: retains the final decision-making power (veto power)

81. -leader utilizes varying styles depending on the situation

82. - should be complementary to manager’s style, expectations & characteristics of workers

84. METHODS OF CARE DELIVERY a. PRIMARY NURSING - total care; 24/7 - sole accountability b. CASE METHOD - Oldest Method; 1:1 - client centered - e.g. ICU nurse c. FUNCTIONAL METHOD - 1nurse 1 task - task oriented d. TEAM METHOD - 1 team 1 group of patient - collaboration oriented * team composition a. RN team leader c. Nursing Aides b. License Practical nurse e. CASE MANAGEMENT - management of specific case through out hospitalization * criteria of cases: a. with specific physician c. by diagnosis b. geographic proximity

85. Communication steps

86. Changing people’s behavior

87. CONFLICT RESOLUTION: Avoidance – reduce tension Accommodation - self sacrifice Collaboration – mutual attention Compromise - both seek acceptable solution Withdrawing – one party is removed Forcing – immediate end but cause unresolved

88. “MANAGEMENT BY LIBRO” By the book established rules, systematic & analytical “MANAGEMENT BY KAYOD” Hard working, dedication, INTROVERT & formal Content oriented “MANAGEMENT BY UGNAYAN” Situational, integritive, most ideal pinoy manager “MANAGEMENT BY OIDO” By ear, based on practical “MANAGEMENT BY LUSOT” Avoid much work, extrovert, & informal Process oriented

90. Centered on QUALITY

91. Based on all member participation/involvement

92. Aim is long term success & improvement

94. www.nursendoutfield.blogspot.com

95. CLASSIFICATION OF PERSONS CRIMINALLY LIABLE: ACCOMPLICE: a person who cooperates “ accessory before the fact”- absent at the time crime is committed. Principal: a. By direct participation- doer of the act b. By inducement-directly force or induce others c. By cooperation- indispensable ACCESSORY: “accessory after the fact” a. Profits b. Conceals/ destroys evidence c. Assists in the escape of the principal

96. Administering Ear Medications Place the client in a side-lying position with the affected ear facing up. Straighten the ear canal by pulling the pinna down and back for children less than 3 years of age or upward and outward in adults and older children. Instill the drops into the ear canal by holding the dropper at least 1⁄2 inch above the ear canal Ask the client to maintain the position for 2–3 minutes.

97. Catheterization

98. Length of catheter insertion male: 6-9 inches female: 3-4 inches

99. Enema Prepare the solution, assure temperature within range of 99° to 102°F by using a thermometer or placing a few drops on your wrist. Wash hands and don gloves. Assist patient to left side-lying position, with right knee bent. Hang bag of enema solution 12 to 18 inches above anus. Lubricate 4 to 5 inches of catheter tip. Separate buttocks, insert catheter tip into anal opening, slowly advance catheter approximately 4 inches. Slowly infuse solution via gravity flow If client complains of increased pain or cramping, or if fluid is not being retained, stop procedure, wait a few minutes, then restart Clamp tubing when fluid finishes infusing; remove catheter tip. Assist client to bedpan, commode, or toilet;

100. Enema If “enema till clear” is ordered, no more than 3 L fluid should be administered in any one series of enemas. Repeated enemas produce irritation of bowel mucosa and perianal area, as well as electrolyte loss and exhaustion. If returns are not clear, consult physician for further instructions.

101. Transmission Based Precaution

102. Anaphylactic Reaction acute systemic hypersensitivity reaction that occurs within seconds or minutes after exposure to certain foreign substances

104. Avoid giving PARENTERAL MEDICATIONS unless absolutely necessary

105. Perform a SKIN TEST (negative skin test results do not always indicate safety)

106. Outpatient, keep at least 30 minutes after injection

109. Wear adequate covering

110. Avoid perfumes, scented soaps, and bright colors

112. Remove the stinger with one quick scrape of the fingernail. (Do not squeeze)

113. Clean with soapy water, and apply ice.