1. Introduction
Comprehensive Review

2. Quality improvement Reports Resources Delegation Roles of nurses
Nursing process
Quality improvement
Reports
Resources
Delegation
Roles of nurses

3. Quality Process Continuity of Care
Focus on the experience of the client . Does the care of the patient flow from care giver to care giver
A philosophy that doing the right thing, the right way, the first time with problem solving that leads to quality outcome
Performance improvement groups are formed to improve standards of care for hospitals
Facilitate the care provided
Act as the liaison and advocate
Initiate revise and evaluate
Report status of the patient from one nurse to the other
Coordinate the care of the patient

4. What if …………
Variance
What is an incident?
Variance or incident –an event that occurs outside of the usual expected normal events. Not intended to point blame just document facts. It confidential and should not be documented in the medical record.
Client injury\
Malfunctioning equipment
Unanticipated adverse reaction
Unethical illegal or incompetent practice
Toxic spills, fire
Violent behavior
Loss or property

5. Resources and consultation..
Case Mangement
Consultation/Referral
Is a collaborative process of assessment and planning
Advocacy for services for the client
Nursing role is to identify when case management would be helpful
Provides expert advice or a formal request for a special service by another caregiver
Nursing role scheduling; calling and giving report

6. Delegation and Prioritization
Delegation –transferring the authority to perform a selected task while maintain the responsibility-CAN
Assigning – transferring the authority and accountability and responsibility to another member RN-assigning med pass to LPN
Supervising monitoring the progress toward completion of delegated task – ultimate responsibility for the outcomes

7. Continued……………. Rights of delegation Delegate or NOT Right person
Right task
Right circumstances
Right direction and communication
Right supervision and elevaluaiton
Process-
Education
Task
Think TEA
Activity time ……………..

8. Which of the following can be delegated?
Shave a client Transfer a client from the bed to the chair Perform tracheostomy care Perform oral suctioning Assist a client who has visual impairment with meals Reposition a client Insert an indwelling cath Feed a client via NG tube Monitor IV Collect a clean-catch urine Record input and output Monitor response to medication Remove antiemboism stockings

9. Which of the following can be delegated?
Shave a client- AP Transfer a client from the bed to the chair-ap Perform tracheostomy care-lpn Perform oral suctioning-lpn Assist a client who has visual impairment with meals-ap Reposition a client-ap Insert an indwelling cath-lpn Feed a client via NG tube=lpn Monitor IV-lpn Collect a clean-catch urine-lpn Record input and output-ap Monitor response to medication-lpn Remove antiemboism stockings –ap Obtain vital signs during a transfusion?

10. Prioritization
life before limb Acute before chronic Actual problems before a potential problem Maslow’s Hierarchy of needs PHYSI before PySCh Trends before transient Emergencies vs complications What procedure should come first –pain med before scheduled med; cath urine before bath

11. Activity Time
Group A
1234
Group B
Group C

12. Terms Autonomy Beneficence Confidentiality Fidelity Justice
Nonmaleficence
Paternalism
veracity

13. Advance directive
Living will- specific plan the client has made Durable power of attorney –legal document that designates another person to make health care decisions DNR- ? What does it include or exclude ?

14. Legal matters Felony Misdemeanor Tort Good Samaritan Law
Impaired co-worker
Malpractice
Negligence

15. Role of the Nurse in an emergency disaster
Emergent or class I red tag- no delay in care
Urgent or Class II yellow tag1-2 hour
Nonurgent or Class III Green- 2-4
Expectant or class IV black- expected to die
Activity time …………..

16. Which triage level would you give?
Number your board 1-12

17. FALLS Older Impaired mobility Cognitive or sensory impaired
Bowel bladder dysfunction
Side effects of medication
History of falls
Yellow arm band; mats non skid socks and leaf on the door? Say what
Review nursing interventions…

18. Restraints
Include human, mechanical, chemical or physical devices that restrict freedom of movement or diminishes access to parts of the body.
Nursing Interventions include>>>>>>>>>>>>>>>

19. 13 steps to seizure care included………….

20. Seizure care

21. Fire Safety

22. Positioning a patient
Semi-fowlers- Trendelenburg Fowlers Modified Trendelenburg High fowlers Reverse Trendelenburg Supine Prone elevation of limb Lateral Dorsal recumbent Sims Semi-prone lithotomy

23. Crutch walking and other ambulation devices
Basics: fit =2-3 finger widths between axilla and top of the crutches
Weight bearing is on the palms not the axilla place crutch tip six inches from feet

24. Continued ……………. Non-weight bearing
Begin in tripod position, maintain weight on the unaffected side
Advance both crutches and the affected side
Move the unaffected weight- bearing foot forward beyond crutches
Continue sequence
Weight bearing
Move crutches forward about one step
Move affected leg forward level with crutch tip
Move the unaffected leg forward
Continue

25. Walking up stairs
1. hold onto rail with one hand and crutches with the other hand
2. Push down on the stair rail and the crutches and step up with the unaffected leg
3. If not allowed to place weight on the affected leg hop up with the unaffected leg
4. bring the affected leg and the crutches up bedside the unaffected leg
5. Remember the unaffected leg goes up first that eh crutches move with the affected leg

26. Walking Down stairs 2 BRING the unaffected leg down
1. place the affected leg and the crutches down on the step below; Support with by leaning on the crutches and the stair rail
2 BRING the unaffected leg down
3 Remember the affected leg goes down first that and the crutches move with the affected leg

27. Cane 1 2 3 4 5

28. Walker 1 2 3 4 5

29. VIDEO

30. Activity……………..