...Original article | Published 3 February 2011, doi:10.4414/smw.2011.13157 Cite this as: Swiss Med Wkly. 2011;141:w13157 Do not attempt resuscitation: the importance of consensual decisions A qualitative study Lorenz Imhofa, Romy Mahrer-Imhofa, Christine Janischb, Annemarie Kesselringc, Regula Zuercher Zenklusend a b c d Zurich University of Applied Sciences ZHAW, Institute of Nursing, Winterthur, Switzerland Department of Education, Training and Professional Development, Stadtspital Waid Zurich, Switzerland Institute of Nursing Science, University of Basel, Switzerland Department of Medicine, Pourtalès Hospital, Neuchâtel, Switzerland Correspondence: Lorenz Imhof PhD RN Zurich University of Applied Sciences Institute of Nursing School of Health Professions Technikumstr. 71 CH-8401 Winterthur Switzerland lorenz.imhof@zhaw.ch pivotal. Therefore, leadership by experienced senior physicians and nurses is needed and great efforts should be made with regard to multidisciplinary education. Key words: decision-making; multidisciplinary collaboration; end-of-life issue; resuscitation orders Introduction Since the 1980s, “do-not-attempt-resuscitation (DNAR)” orders have become common in medical practice. DNAR orders are given for 50–60% of patients who die a non-sudden death, with wide variations among countries. DNAR orders apply to only 19% of hospitalised patients in Italy, but to as many as 83% in Sweden and 86% in Switzerland [1, 2]. The frequency of DNAR decisions in...
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...SITUATION : Arthur, A registered nurse, witnessed an old woman hit by a motorcycle while crossing a train railway. The old woman fell at the railway. Arthur rushed at the scene. 1. As a registered nurse, Arthur knew that the first thing that he will do at the scene is A. Stay with the person, Encourage her to remain still and Immobilize the leg while While waiting for the ambulance. B. Leave the person for a few moments to call for help. C. Reduce the fracture manually. D. Move the person to a safer place. 2. Arthur suspects a hip fracture when he noticed that the old woman’s leg is A. Lengthened, Abducted and Internally Rotated. B. Shortened, Abducted and Externally Rotated. C. Shortened, Adducted and Internally Rotated. D. Shortened, Adducted and Externally Rotated. 3. The old woman complains of pain. John noticed that the knee is reddened, warm to touch and swollen. John interprets that this signs and symptoms are likely related to A. Infection B. Thrombophlebitis C. Inflammation D. Degenerative disease 4. The old woman told John that she has osteoporosis; Arthur knew that all of the following factors would contribute to osteoporosis except A. Hypothyroidism B. End stage renal disease C. Cushing’s Disease D. Taking Furosemide and Phenytoin. 5. Martha, The old woman was now Immobilized and brought to the emergency room. The X-ray shows a fractured femur and pelvis. The ER Nurse would carefully monitor Martha for which of the following...
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...Practice Examination One Part One You will have two hours and 30 minutes to complete Part One. 1. The nurse is instructing an unlicensed assistant on how to collect a urine specimen from an indwelling catheter. Which of the following statements indicates that the assistant understands the instructions? A. "I will empty the catheter drainage bag, have the client drink some water, and an hour later collect the urine that drains into the bag. " B. "I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container. " C. "I should collect urine from the catheter drainage bag at the end of the shift and place it in the specimen container. " D. "I will disconnect the drainage tube from the catheter and let urine run from the catheter into the specimen container. " 2. Linda is a 19-year-old primipara who delivered a viable male neonate 2 hours ago. She has decided to breast-feed. Her 22-year-old husband supports her decision. She tells the nurse, "My mother breast-fed all of her children, but I'm going to need lots of help with breastfeeding. I'm worried that I won't be able to do this. " Which of the following should the nurse include when assessing the client? A. Determine the client's level of motivation to breast-feed. B. Perform a complete physical examination to determine her need for help. C. Assess her body-to-fat ratio and nutritional status before beginning...
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...THE NEWBORN WITH SPECIAL CONSIDERATIONS A preterm infant is usually defined as a live-born infant born before the end of week 37 of gestation; another criterion is a weight of less than 2,500 grams (5lb 8oz) at birth I. INCIDENCE Occurs approximately 7% of live births of white infants, in Afro-American infants the rate is doubled 14% (Thilo & Rosenberg, 2003) CAUSES/FACTORS ASSOCIATED WITH PRETERM BIRTHS 1. Low socio-economic status 2. Poor nutritional status 3. Lack of prenatal care 4. Multiple pregnancy 5. Previous early birth 6. Race (non-whites have higher incidence than whites) 7. Cigarette smoking 8. Age of the mother (highest incidence is in mothers younger than age 20) 9. Order of birth (early termination is highest in first pregnancies and in those beyond 4th pregnancies) 10. Closed spaced pregnancies 11. Abnormalities of mother’s reproductive system, such as intrauterine septum 12. Infections (especially UTI) 13. Obstetric complications (PROM, premature separation of placenta 14. Early induction of labor 15. Elective cesarean birth ASSESSMENT A. History – detailed pregnancy history will reveal reason for the preterm birth; be careful not to convey disapproval of reported pregnancy behaviors such as smoking, etc. Being overburdened with guilt may be detrimental to her attempts to bond with her infant B. Appearance Criteria Posture Premature infant Resting posture – characterized by very little, if any, flexion in upper extremities and only partial flexion of...
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...China and the United States, with their deepset communitarian vs. individualistic ethics, respectively, typify divergent cultures. This paper discusses cross-cultural differences in norms of truth-telling to cancer patients, that is, the extent to which physicians inform patients themselves of their disease status when prognosis is poor; China and the US are used to illustrating potential differences in approach and consequent cross-cultural misunderstandings. In an increasingly mobile global community, in which information technology and telecommunications span cultures and patients are increasingly well informed, clinicians around the world would be well advised to become aware of the communication styles and expectations, and to make an effort to understand the norms, of their patients’ cultures of origin....
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...4) The naughty nurse 5) The military image A. Nurses on the battlefield * Hospitalers – specialized soldiers who at the end of battle returned to the outposts to care for the sick and injured * Army nursing service – organize nurses and hospitals and coordinate supplies for the soldiers during the Civil War * Clara Barton a. Provided care in tents set up close to the fighting b. Did not discriminate c. Establishment of the American Red Cross * Harriet Tubman – helped slaves escape to freedom on the underground railroad * Walt Whitman – a poet * Louisa May Alcott – an author * Dorothea Dix – union’s superintendent of female nurses during the Civil War B. Nurses fighting diseases * Florence Nightingale d. Epidemiology – the study of the distribution and origins of disease e. Air, light, nutrition, and adequate ventilation and space assist the patient to recuperate * Lillian Wald & Mary Brewster f. Founded the Henry Street Settlement in NY to improve the health and social conditions of poor immigrants g. Improve health and prevent illness by promoting safe drinking water, adequate sewage facilities, and proper sanitation Florence Nightingale (1820-1910) * “Lady of the Lamp” * Walked through the camp at night providing care to the sick and wounded during the Crimean War ...
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...Assessment Technologies Institute®, LLC Copyright © 2014 Assessment Technologies Institute, LLC. All rights reserved. The reproduction of this work in any electronic, mechanical or other means, now known or hereafter invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the content in this publication, including, for example, the cover, all of the page headers, images, illustrations, graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by third parties who have licensed their materials to Assessment Technologies Institute, LLC. important Notice to the reader Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for informational and educational purposes only and may be modified or updated...
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...In This GUIDE Welcome to Houston Methodist St. John Hospital ___________________________ 2 About Us_______________________________________ 3 Travel Directions____________________________ 4 Telephone Directory ______________________ 5 During Your Stay ________________________ 6-8 Visiting Hours__________________________________ 6 Parking_________________________________________ 6 Cell Phones_____________________________________ 6 Calling Your Nurse______________________________ 6 Telephone ______________________________________ 6 Fire Safety______________________________________ 6 Smoking________________________________________ 6 Electrical Appliances___________________________ 6 Mail and Flowers_______________________________ 6 Gift Shop________________________________________ 6 Spiritual Care___________________________________ 7 ATM_____________________________________________ 7 Patient Meals___________________________________ 7 Snacks__________________________________________ 7 Guest Trays_____________________________________ 7 Vending Machines_____________________________ 7 Cafeteria________________________________________ 7 Financial Expectations for Admissions________ 7 Wireless Internet Access_______________________ 7 Valuables_______________________________________ 8 TV_______________________________________________ 8 Television Channel Listings____________________ 8 Your Privacy & Information___________15 Do You Have Pain? ________________________16 ...
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...and Carbon Dioxide Transport Section II - Preventive Practices in the Critically Ill Preventive Practices in the Critically Ill Chapter 3 - Infection Control in the ICU Chapter 4 - Alimentary Prophylaxis Chapter 5 - Venous Thromboembolism Section III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia and Hypercapnia Chapter 20 - Oximetry and Capnography Chapter 21 - Oxygen Inhalation Therapy Chapter 22 - Acute Respiratory Distress Syndrome Chapter 23 - Severe Airflow Obstruction Section VIII - Mechanical Ventilation Mechanical Ventilation Chapter 24 - Principles of Mechanical Ventilation Chapter 25 - Modes of Assisted Ventilation Chapter 26 - The Ventilator-Dependent Patient Chapter...
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...A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. reason for the nurse to elevate the casted leg is to A) Promote the client's comfort B) Reduce the drying time C) Decrease irritation to the skin D) Improve venous return The most important D: Improve venous return. Elevating the leg both improves venous return and reduces swelling. Client comfort will be improved as well. 2. The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client? A) B) C) D) Clean the meatus, begin voiding, then catch urine stream Void a little, clean the meatus, then collect specimen Clean the meatus, then urinate into container Void continuously and catch some of the urine A: Clean the meatus, begin voiding, then catch urine stream. A clean catch urine is difficult to obtain and requires clear directions. Instructing the client to carefully clean the meatus, then void naturally with a steady stream prevents surface bacteria from contaminating the urine specimen. As starting and stopping flow can be difficult, once the client begins voiding it’s best to just slip the container into the stream. Other responses do not reflect correct technique 3. Following change-of-shift report on an orthopedic unit, which client should the nurse see first? A) B) C) D) 16 year-old who had an open reduction of a fractured wrist 10 hours ago 20 year-old in skeletal traction...
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...and clinical nursing standards. • Discuss the development of advanced clinical practice nursing from the 1960s through the present. PROFILE IN PRACTICE Laura J. Robinson Adult Primary Care Nurse Practitioner Student, University of Connecticut School of Nursing Nursing history is important to me because it has provided me with the opportunity to fulfill my goal to advance my career as a nurse practitioner, a role that was not existent less than half a century ago. Ambitious nurses before me had to establish themselves in a new career, gain recognition, and succeed in order for the position to be present today. One person whom I particularly admire and who helped pave the way is my grandmother, Olive Shea. Grandma Shea earned her RN diploma in 1944 after completing the 3-year certification program offered by Hartford Hospital in Hartford, Connecticut. After various nursing positions, she was employed by the University of Connecticut at the campus Infirmary in Storrs, Connecticut, beginning in 1968. At that time the facility was the home to physicians whose time was mainly devoted to scheduled appointments with their student patients, as well as two floors of inpatient beds where nurses provided individualized care. Grandma Shea recounted that an integral part of her day as a nurse was the 20-minute back rubs she gave to all five...
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...any liability assumed for damages resulting from the use of the information contained herein. ISBN-13:978-0-7897-2706-9 ISBN-10: 0-7897-3706-x Library of Congress Cataloging-in-Publication Data Rinehart, Wilda. NCLEX-PN exam cram / Wilda Rinehart, Diann Sloan, Clara Hurd. -- 2nd ed. p. cm. ISBN 978-0-7897-3706-9 (pbk. w/cd) 1. Practical nursing--Examinations, questions, etc. 2. Nursing--Examinations, questions, etc. 3. National Council Licensure Examination for Practical/Vocational Nurses--Study guides. I. Sloan, Diann. II. Hurd, Clara. III. Title. RT62.R55 2008 610.73'076--dc22 2008000133 Printed in the United States of America First Printing: February 2008 Trademarks All terms mentioned in this book that are known to be trademarks or service marks have been appropriately capitalized. Pearson Education cannot attest to the accuracy of this information. Use of a term in this book should not be regarded as affecting the validity of any trademark or service mark. Warning and Disclaimer Every effort has been made to make this book as complete and as accurate as possible, but no warranty or fitness is implied. The information provided is on an “as is” basis. The...
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...University May 10, 2013 Abstract Breadth Component In this age of rapidly evolving technological advances, many of the legal and ethical issues that are challenging the delivery of health care and the health care profession are new. As we confront the legal, moral, and ethical aspects of health care, we are seldom faced with decisions that require or are resolved by simple right or wrong answers (Edge & Kreiger, 1998). In the Breadth component of KAM VI, I focus on several ethical theories and how those theories influence the way ethical issues and concerns are addressed and managed in the allocation and delivery of health care services. I critically assess and evaluate those theories, concepts, and derivative principles as they impact important decisions and the implications of those decisions within the context of social change and with special emphasis on health care management and policy. In addition, I discuss the key assumptions on which the selected theories are constructed, compare and contrast the writers’ interpretations across theories, and conclude by providing a critical commentary on the merits of the selected theories. Abstract Depth Component In the Depth Component of KAM VI, I review and critically analyze selected articles on contemporary concepts and methods in ethical decision-making relative to the delivery of health services. I also attempt to build on the theories, perspectives, and conclusions discussed in the Breadth Component, and compare...
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...Patient Safety Workshop Learning From Error PATIENT SAFETY WORKSHOP LEARNING FROM ERROR WHO Library Cataloguing-in-Publication Data Patient safety workshop: learning from error. Includes CD-ROM 1.Patient care - standards. 2.Medical errors - standards. 3.Patient rights. 4.Health facilities - standards. 5.Health Management and Planning. I.World Health Organization. ISBN 978 92 4 159902 3 (NLM Classification: WX 167) This publication is a reprint of material originally distributed as WHO/IER/PSP/2008.09. © World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies...
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...critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies. Chronic critical illness is a devastating condition: mortality exceeds that for most malignancies, and functional dependence persists for most survivors. Costs of treating the chronically critically ill in the United States already exceed $20 billion and are increasing. In this article, we describe the constellation of clinical features that characterize chronic critical illness. We discuss the outcomes of this condition including ventilator liberation, mortality, and physical and cognitive function, noting that comparisons among cohorts are complicated by variation in defining criteria and care settings. We also address burdens for families of the chronically...
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