...EMERGENCY DEPARTMENT 1) Describe the role of the nurse in the pre-procedure area. The nurse is responsible for initial assessment of the patient, initiating IV access, administering oxygen, placing EKG leads on the chest, documenting vital signs, and draws the blood samples for the lab. The nurse calls the doctor when she had prepared the patient unless there is an immediate need for the doctor’s intervention. The nurse administers medication, usually IV. If language barrier occurs, the nurse can use a Language Line for the official translation to foster the communication with the patient. 2) Observe the role of the nurse in correctly identifying patients and their scheduled procedures, including time-out and verification processes. N/A 3) Identify the role of the nurse in maintaining sterile fields and aseptic technique. The nurse uses standard precautions and maintains clean technique at all times. The nurse uses sterile gloves for IV access placement. 4) Differentiate between procedural and informed consents. The procedural consent is signed by the physician who is going to perform the procedure and the informed consent is signed by the patient who agrees to such procedure to be performed. 5) Identify the role of the nurse in obtaining/verifying informed consent. The nurse verifies that the informed consent is signed before any invasive procedure is initiated. For example, the lumbar puncture requires informed consent. 6) Identify the...
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...Consumer Name: Date: 12/5/12 RN Plan of Care: 1. Perform S-SAM’s Assessment annually per LVN to re-evaluate ability/knowledge to self-administer routine and ‘prn’ medication, OR with competent staff supervision OR appropriateness of RN exemption/delegation for medication administration (1hr/yr- LVN; 1hr/yr-RN) 2. Complete LVN focused nursing assessment on admission and semiannually to obtain current medical data to monitor decline/improvement of current medical and/or psychiatric diagnosis. (2 hrs/yr- LVN) 3. RN will perform QA review of chart annually to monitor compliance/recommendations of medical/dental/vision/consultant appointments, and intended effects of routine and ‘prn’ medications and to develop the RN Plan of Care for annual IP. (4hrs/yr- RN) 4. RN will perform a follow-up QA of chart within 90 days of annual QA to confirm compliance to DADS regulations and to RN Plan of Care. (1hr/yr-RN) 5. Perform verification of current MD orders on pharmacy printed MAR (3hrs/yr-LVN) 6. Perform verification of compliance to medication/treatment orders documented by unlicensed staff on MAR (3hrs/yr-LVN) 7. Nurse to monitor monthly weight and inform PCP of weight gain/loss > 8lbs (1hrs/yr-LVN)(1hrs/yr-RN). 8. Nurse to provide annual residential/day habilitation staff education/training on SAM’s process in order to deem staff competent to administer medications per BON-RN Delegation.(2hr/yr-LVN) (2hrs/yr-RN) 9. Provide RN on-call after office hours to triage/assess...
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...1. In Excel, use a suitable method for generating the number of days needed to repair the copier, when it is out of service, according to the discrete distribution shown. I calculated the cumulative distribution, random number ranges and average repair days below. Machine Repair time, y (days) | Probability of Repair time | Cumulative Probability | Random Number Range, r2 | | 1 | 0.20 | 0.20 | 0.00-0.20 | 0.2 | 2 | 0.45 | 0.65 | 0.21-0.65 | 0.9 | 3 | 0.25 | 0.90 | 0.66-0.90 | 0.75 | 4 | 0.10 | 1.00 | 0.91-1.00 | 0.4 | Average repair days | 2.25 | To find the repair time I used VLOOKUP /y days =VLOOKUP to probabilities in the Repair Time probability/ tool generating random number /which r2=RAND()/. If 0 < r2 < 0.2, then repair time is 1 day. If 0.02 < r2 < 0.65, then repair time is 2 days. If 0.65 < r2 < 0.90, then repair time is 3 days. If 0.9 < r2 < 1, then repair time is 4 days. r2 | Repair Time y days | 0.157479 | 1 | 0.319876 | 2 | 0.268242 | 2 | 0.616901 | 2 | 0.195559 | 1 | 0.563 | 2 | 0.886715 | 3 | 0.568449 | 2 | 0.758294 | 3 | 0.0156 | 1 | 0.020516 | 1 | 0.287682 | 2 | 0.988455 | 4 | 2. In Excel, use a suitable method for simulating the interval between successive breakdowns, according to the continuous distribution shown. r1 | Time Between Breakdowns, x weeks | Cumulative Time Between Breakdowns | 0.029508 | 1.030669 | 1.030669 | 0.987177 | 5.961406 | 6.992075 | 0.0002 | 0.08491 | 7...
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...patients the RN made the following assignments. See appendix for a full description of each patient: Assignments | | Macy LPN #1 | Pod 1 | | Mr. Black (UTI) | | Ms. Johnson (Crohn’s) | | Mr. Raynor (diabetic foot ulcer) | | Mrs. Tolento (CHF) Mr. Smith (pneumonia) | | Ms. Swanson (S/P hysterectomy day 2, in pod 2) | Ana RN | Pod 2 | | Mr. Smith (GI Bleed) | | Mr. Moretz (Night sweats, neg pressure room) | | Mrs. Flanco (S/P Colectomy day 2)Mr. Reddington (GSW) | Mike LPN #2 | Pod 3 | | Mr. Smith (Atrial Fib) | | Ms. Harper (s/p breast mastectomy) | | Ms. Levin (s/p attempted suicide) | | Mrs. Walnut (aspiration pneumonia)Mrs. Stewart (Diabetic Ketoacidosis) | | | Gilda CNA | Pods 1-3 | | | Explanation The following is a detailed explanation of the assignments made for this shift: Macy LPN: Macy was given her patients based of her skill and scope. She always volunteers to take on the Spanish speaking patients since she is more comfortable speaking in Spanish. The RN, after moving patients to different pods, she gave Macy one possible discharge today and what would be consider by some a difficult patient that can be abusive and refuses to be take care of be the other LPN on shift today. Macy also had to take on a total of 6 patients instead of six, the RN will cosign her notes at of shift. The patients given to Macy also had the least amount of IV medications to be given and this would be beneficial to the RN, since Macy...
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...the drug stores in the community. Technicians are responsible for processing prescriptions in the computer and preparing and labelling medications as well as inventory management functions. Pharmacists are responsible for reviewing the patient medication profile and completing the final check of the medications before they are dispensed for pick-up or home delivery. Some attending physicians at the Community Hospital fax a prescription to the patient’s drug store so that patients and families can easily pick-up any needed medications on the way home. The incident involves a 76-year-old male home care client receiving a leg ulcer dressing change every five to seven days. The patient is obese and has a history of angina, high blood pressure and deep vein thrombosis. He has limited mobility and was in hospital for eight days with a diagnosis of community-acquired pneumonia. The patient was discharged on a Saturday with a...
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...LPNs (licensed practical nurse) role is to provide care to patients on a day to day basis, based on the needs determined by the RN or physician. The responsibility of the LPN is to perform basic medical procedures such as changes in conditions of patients to the RN or physician. The LPN in their role is also able to perform wound care to injuries based on orders from RN or physician. The LPN is vital for recording important data on residents, such as condition, vital signs, and progress towards goals. Anything that is “observed” by the LPN that is pertinent to the care of the patient should be reported to the RN or physician for proper follow up. The LPN is able to manage patient s in doctor offices, home settings, and nursing home/rehabilitation facilities (The Role of Licensed Practical Nurse in a Hospital, 2013)....
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...within the hospital environment. For examples, hospitals are no longer reimbursed for the cost of diabetic ulcer treatment acquired while the patient is in the hospital. The quality of the expected result is much higher while the reimbursement is much lower. Hospitals have to look closely at how the nursing staff delivers care to the patients. The traditional bedside nursing is staffed by three levels of nurses. Certified Nurse’s Assistant (CNA), Licensed Vocation Nurse (LVN), and the Registered Nurse (RN). Other levels of nurses such as Nurse Practitioners and other advanced practice nurses are not included in the bedside staffing ratios. This paper will discuss the change that occurred in a teaching hospital, in the Los Angeles area. That change took place in the 2008. CNA’s, traditionally, take the patient’s ‘vital signs’ which include temperature, blood pressure, heart rate, respirations, oxygen saturation percentage and the pain level. The CNA’s relays the information to the RNs, who use the results...
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...There are many similarities between a RN and an APRN physical examination, yet there are differences as well. Both a RN and an APRN are conducting physical exam to determine and differentiate normal from abnormal findings. Both will used a general survey to gather patient history and perform head to toe physical exam. Both might gather information on family history, smoking history, nutrition history, and so forth. In addition, they will perform complete head to toe assessment of the body systems. In an acute care setting, I believe that a RN spend more time on initial assessment during admission and on subsequent days the assessment is not thorough. In addition, the RN are entitled to check vital signs in acute setting or an LPN checks vital...
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...clinicians. Registered nurses can progress from registered nurse (RN) 1 through 4 by demonstrating superior clinical expertise and completing a combination of continuing education courses Advanced training or professional certification, participating in research and by demonstrating continued development clinical practice. Through self-development activities, continuing education and professional development, you have the opportunity to move up the clinical ladder, achieving greater responsibility and accountability as you progress. Applicants are reviewed and approved by your peers. Clinical ladder promotions are rewarded financially at each step in the ladder. ADVANCE program eligibility • registered nurse (RN) clinician • Budgeted and benefit-eligible employee • RN that has successfully completed the probationary period (first 90 days of employment) • RN that is not in the positive discipline process • Performance appraisal at present level is rated competent (3) or above in each performance standard Application process • Performance appraisals • Clinical narrative(s) • Self-development hours • Advancement levels The ADVANCE Program provides the opportunity for the RN to apply for advancement to RN 3 and RN 4. Continued movement up the ladder (after RN2) is a voluntary progressive advancement program. A nurse must complete the RN 3 level before progressing to RN 4 level....
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...The health care industry is booming. People interested in starting a health career are in good company. Thousands join the health care profession every day. Those that enjoy helping people and working in a medical environment should consider an online rn program. Those that become a rn find the work challenging and very fulfilling too. The way to start the journey to fulfilling this career goal starts at a resident nurse school. RN Career The RN or Registered Nurse provides critical care to patients and instructs the patient and family on the proper way to provide needed care for various health conditions. The RN is also there to provide emotional support for the patient and their family. Certainly, this medical professional is a vital part...
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...Meeting February 23, 2016 ATTENDANCE: Unit Supervisor: Romena C. Jaso, RN Presiding Officer/ Head Nurse: Nanette A. Suico, RN Staffs Present: 1. Catherine O. Bitantos RN 2. Angelyn R. Bautista, RN 3. Kaye Angeline D. Becira, RN 4. Nikka Vanessa P. Buyco, RN – Absent without notice 5. Genelyn M. Floro, RN 6. Arvin Paul M. Ganoy, RN 7. Mary Grace R. Lape, RN 8. Editha B. Mundala, RN 9. Jean Mae Anobling 10. Arnold Bautista 11. Vanessa Ann N. Sobiono 12. Cherry Mae Cameros Auxillary Nurses: 1. Erica Adrienne G. Persigo, RN 2. Jaydee Marie D. Ronolo, RN 3. Genneth T. Apolinario, RN Call to Order and Determination of Quorum There were sixteen out of seventeen (16/17) staffs, nursing attendants and auxiliary nurses who were extant thereby the said meeting. Held at Medicine Extension and was in quorum at exactly 8:25pm, aided by Ms. Nanette Suico, RN the unit head. It started with a prayer headed by Ms. Cherry Mae Cameros, followed by the reading of previous minutes of meeting by Ms. Mary Grace Lape, RN. On the motion made by Mr. Arvin Paul Ganoy, RN it was agreed and seconded by Ms. Cherry Mae Cameros. There were few matters arising been discoursed and laid importance on the previous meeting, cases like; ISSUES | DISCUSSIONS | RESOLUTIONS | 1. SPMS(Strategic Performance Management System) | Ms. Nanette Suico, RN discoursed about the old form of SPMS formerly called PES (Performance Evaluation...
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...RNQuiz.com - NCLEX-RN Study Guide Neonatal Care 1 Cardiovascular system: o Closer of the foramen ovale secondary to: Expansion of the lungs, decreases pulmonary resistance Clamping of umbilical cord: Increases systemic vascular resistance Increases left atrial pressure Respiratory system: o First breath is a reflex to noise and light Renal system: o Not fully functional for the first year o Neonate’s ability to filter waste products improve over first year of life Gastrointestinal system: o No normal bacterial flora o Unable to digest fat Thermogenesis: o Rapid heat loss can occur in less than optimal environment Immunity: o Depends on immunity provided by mother o Neonate begins to development of own immune system within 3 months Hematopoietic system: o Prolonged coagulation time secondary to low vitamin K levels RNQUIZ.com Changes in the Neonate post delivery: RNQuiz.com - NCLEX-RN Study Guide Neurologic system: o Equal strength and symmetrical responses and reflexes Hepatic system: o Physiological jaundice is mild and last first few days after birth Apgar Assessment: 2 This is a way to evaluate the neonate’s cardiopulmonary and neurological status at 1 and 5 minutes after birth. A score of 8-10 indicates no immediate distress, less than 8; possible CPR. Sign Heart rate Respiratory Muscle tone Reflex irritability Color 0 Absent Absent Flaccid None Pale blue 1 Less than 100beats/min...
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...significant pain score of 10/10 * At the patients time of arrival there was 1 RN, 1 LPN, 1 Secretary, 1 Emergency room physician, and an in house respiratory therapist on staff at the time of the patient’s arrival and there were two other patients being cared for. * The physician decides to do a reduction of the patients left hip and need to have the patient at an appropriate sedation level * At 4:05pm the nurse administered Diazepam 5mg IV per the physicians order. * At 4:15pm the nurse gave Hydromorphone 2mg IV per the physicians order. * At 4:20pm the patient is still not sedated enough and the nurse gives an additional Diazepam 5mg IV and Hydromorphone 2mg IV. * At 4:25 Proper sedation is achieved and the physician performs a reduction of his left hip. * At 4:30pm the procedure was complete and the nurses are alerted to another patient in route to the ER in acute repertory distress and the nurse places the patient on an automatic blood pressure machine to monitor B/P and pulse oximetry. * At 4:35pm the patient had a B/P reading of 110/62 and O2 stat of 92% * The nurse and LPN receive the ER transport patient and are now discharging the other two patients but the ER has filled with new incoming patients. * The patients O2 saturation alarm is showing a low O2 saturation of 85%, the LPN enters the room and resets the alarm and repeats the B/P reading * The RN...
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...Application of Benner’s theory to problem of delegation Introduction A frequent problem at work is that registered nurse's (RNs) are often reluctant to delegate tasks to unlicensed assistive personnel (UAP). Many patients at the hospital suffer from strokes, spinal injuries, brain tumors, dementia/Alzhiemer’s disease, or other devastating illnesses/injuries. Also, large hospitals and hospitals in urban areas tend to have numerous patients at the hospitals at any given time. Every day hospital units are quite busy and nurses are required to turn, feed, constantly observe for patient safety, bathe, and assist with elimination. RNs need to delegate the tasks or responsibilities to unlicensed assistive personnel (UAP) or other healthcare professionals....
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...Affect the Quality of Patient Care? Pam Glasper Beaumont Hospital Wayne How Does Mandatory or Voluntary Overtime Affect the Quality of Patient Care? Registered Nurses (RNs) constitute an integral part of the patient care and recovery process. To many patients, nurses are the health care professionals they see most often. Additionally, patients seeking care in outpatient clinics may not be aware of the number of hours nurses work. However, short stay and long stay patients see the same nurses over many shifts. What they may not realize is how many hours RNs work in a given 24-hour period to provide continuous patient care. According to Bae (2012a), a 2004 research study found that “43% of U.S. RNs worked more than 40 hours per week and about 9% worked more than 60 hours per week” (p. 205). In most instances RNs work overtime to alleviate staff shortages in their units. According to Bae (2012b), staff shortage in hospitals is not a new phenomenon and many researchers in health care system contend that such chronic shortage of nurses has a direct and negative impact on patient care (Bae, 2010; Bae, 2012b, Bae, Brewer, & Faan, 2012). For example, in several of her research articles, Bae (2010, 2012a, & 2012b) cited several research articles where researchers have found that the long hours worked by RNs are at the root of many adverse patient outcomes. Anecdotal evidence should suggest that anyone working long hours over an extended period of time will experience fatigue...
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