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Side A ------ Side B Constitutional Law ------ Rules and principles that describe the powers of government and peoples' rights. Addresses relationship between people and their government Statutory/Legislative Law ------ Governs society- basic rules which are written by legislature or congress Administrative Law ------ set by appointed agencies of government basic rules applied to specific groups (Ohio Board of Nursing) Common Law ------ court made law based on interpretaion of statutory law (Roe VS Wade) Criminal Law ------ Offense that causes harm to society in general (jail, fine, or both) Civil Law ------ Affects legal rights of individuals or corporations (more likely than not that the incident happened) Tort ------ private wrong against a person or their property by act or omission Intentional Tort ------ Assault & battery, false imprisonment, defamation, breach of confidentiality Unintentional Tort/Negligence ------ person does not act in a resonable matter and causes harm or damage to a person or their property Malpractice ------ Negligent conduct of a professional person Liabiltiy ------ Legal responsibility Breach of Duty ------ Failure to comply with standards of care *** The 6 rights of administering medication ------ 1. Right patient 2. right medication 3. right dose 4. right route 5. right time 6. right documentatin What are "Standards of Practice" ------ that of which the average qualified healthcare provider of the same training and background would provide under the same circumstances What are "Standards of Care" ------ describe outcomes of care, focus on patient Risk Management ------ Process that centers on identification analysis, treatment, and evaluation of real and potential hazards Name strategies to deal with potential hazards and reduce risk of liability ------ 1. informed consent 2. documentation 3. unusual occurance reports 4. Professional liabilty 5. sentinel events Informed consent ------ Without this, IV is assault and battery. Patient must be capable of giving consent, must receive necessary information to make informed decision, must not be coerced Five examples of what should be reported on an Unusual Occurrence Report ------ 1. Patient admitting diagnosis 2. Date/time incident 3. room # 4. name & age 5. type of incident What are the recommended documenting guidelines of IV complaints/discomfort? ------ Date/time, vein specific insertion location, brand model/style of device, gauge & length, infusion solution, gravity or pump, rate of flow, patient comments & teaching When should a medical device be reported to the FDA? ------ when it's faulty What is some common device problems related to IV's? ------ contaminated infusate, skin organisms, device contaminated prior to insertion, cath hub contaminated, hematogeous, thrombus Elements of IV competency: Accountability ------ Nurse must be knowledgable enough to adjust interventions for long term & short term goals Communication ------ Complete data through documentation Collaboration ------ JCAHO demands (consult with other staff) Autonomy ------ Independant decision making List 5 physical occupational hazards and how they can be prevented ------ 1. Needlesticks (guards) 2. Abrasion (watch sharp objects) 3. Contusion (watch sharp objects) 4. Chemical exposure (double glove) 5. latex allergy (avoid exposure) Quality Assurance ------ Policys and procedures that promote better outcomes Quality management ------ Systemic process to ensure positive patient outcomes According to 4723.17 Ohio Revised Code: List 5 procedures a qualified LPN MAY PERFORM ------ 1. Prepare an adult for IV therapy 2. Assemble and maintain equiptment for gravity drip infusion 3. Initiate infusion of IV solution as directed by authorized person 4. Maintain those solutions 5. Regulate peripheral IV List 5 procedures a qualified LPN MAY NOT PERFORM ------ 1. Initiating blood components 2. Initiating or maintaining central venous line 3. Initiating on person under 18 4. Discontinuting any other than peripheral IV 5. Administering meds via IV line Epidemiology ------ Study of diseases injury and causes Antigens ------ Invaders that trigger the immune system What are the primary organs of the immune system? ------ Thymus & Bone marrow What are the secondary organs of the immune system? ------ Lymph nodes, spleen, liver, peyer's patches, appendix, tonsils, adenoids Nonspecific Immune Response ------ present at birth (function without antigen) Specific Immune Response ------ acquired functions (prior to exposure) Active Immunity ------ vaccine or have the disease Passive Immunity ------ use someone elses antibodies (maternal) Signs/symptoms of immunosuppression ------ Frequent infections, more severe, rare infection agents, incomplete response to treatment Colonization ------ Microorganisms replicate without signs and symptoms Carrier ------ a colonized person--- No signs and symptoms Dissemination ------ sheding microorganisms Nosocomial Infection ------ Hospital aquired (after 72 hours) What is the most common microorganism that causes IV related infections? ------ Coagulase Negative Straphylococci Chain of Infection: Causative agent ------ Causes infection Reservoir ------ Place where it grows Portal of Exit ------ Place where it passes from source to host Method of transmission: Direct transmission ------ Touching it.. (Droplet within 3 feet) Indirect transmission ------ indirect object carries the germ 3 types: 1. Vehicle borne: water, food, tourniquet 2. Vector borne: animal, insect 3. Airborne: attach to dust Portal of Entry ------ way it enters the body of host Susceptible Host ------ person at risk for infection What are the three stages of antibiotic use? ------ 1. infection suspected 2. adjusted to microbial agent (ID'd) 3. Patient shows improvement Pharmacoepidemiology ------ benefit and adverse effects to drugs Emporiatirics ------ study of disease in travelers What is infusion phlebitis, include signs and symptoms ------ protective response of vein to irritation, injury, or invasion by disease producing organisms What are 3 factors that cause infusion phlebitis? ------ 1. Irritation 2. Injury 3. Invasion of organisms List 4 of the stategies to prevent/treat infections ------ 1. use recommended precautions 2. wash hands 3. no artificial or long nails 4. use skin antisepsis What is the number one way to prevent infection? ------ wash hands What are the 15 steps in Phillips 15 step method? Precannulation ------ 1.Check order 2. Wash hands 3. Prep equiptment 4. Assess patient 5. Site selection/vein dialation Cannulation ------ 6. Needle selection 7. Glove up 8. Site prep 9. Vein entry 10. Stabilize cath and dress Postcannulation ------ 11. Label 12. Dispose of equipment 13. Educate 14. Calculate rate 15. Documentation What are the two kinds of delivery systems? ------ 1. Glass system 2. Plastic system What type of tubing is needed with the glass system? ------ vented tubing or long straw Coring and how do you prevent it? ------ Spiking through rubber stopper can cause rubber shreds to get into solution, (microscopic) could = emboli List two advantages of the glass system ------ 1. clear 2. good visualization of fluids/contents 3. easy to read level 4. inert, no plastics to react List two disadvantages of glass system ------ 1. Breakage 2. bulky to store 3. hard to spike 4. disposal 5. rigid How do you check the glass system and what are you looking for? ------ 1. Hold up to light, check for rainbows, must be clear, no floaters, no cracks, no flashes of light, expiration date What are three contributing factors that could cause leakage in the plastic system? ------ 1. Length of storage 2. heat 3. agitation 4. blood products 5. fat emulsions 6. certain drugs Does the plastic system need vented tubing or nonvented? ------ doesn't need it but can use either List two advantages of the plastic system ------ Closed system, flexible, light weight, composed of one substance, easy storage List two disadvantages of the plastic system ------ easily punctured, fluid level difficult to determine How do you check the plastic system and what would you be looking for? ------ Inspect outer bag with inner bag (obvious condensation, inner wet?) Squeeze for pin holes. Hold to light look for clarity, no color, no floaters, expiration date, label (right solution) Spike ------ tops drip chamber, sharp tip, do not touch (must stay sterile) Flange ------ plastic guard next to spike, hold behind flange to spike Drop orifice ------ hole opening that determines drop size, determines the drop factor (10,20, or 60 gtt/min) or micro or macro drip Drip chamber ------ connected to tubing (clear- can see to count drops) tubing ------ primary/standard sets 66-100" long, vented or nonvented-- Secondary 32-42" long. Each contains clamps, ports, connectors, filters, available macro or micro Clamps ------ compress tubing to reduce/stop flow (roller, slide, or screw) Injection ports ------ access for admin of meds, membrane covered, use 25 gauge needle for good reseal Backcheck valve ------ Keeps piggyback solution from getting into primary, allows primary to restart when piggyback is finished Hub ------ connects the administration set to the IV catheter, needleless system also called the male luer-lock Final Filter ------ Removes foreign particles, blood set has specific filter, some remove air only Macrodrip tubing ------ 10-20 big drops= 1mL Microdrip tubing ------ 60 tiny drops=1mL What is the INS Standard for changing administrative sets? ------ Change continuous sets every 72 hrs and when suspected of contamination. Primary intermittent sets change every 24 hours and immediately with suspected contamination
Side A ------ Side B Constitutional Law ------ Rules and principles that describe the powers of government and peoples' rights. Addresses relationship between people and their government Statutory/Legislative Law ------ Governs society- basic rules which are written by legislature or congress Administrative Law ------ set by appointed agencies of government basic rules applied to specific groups (Ohio Board of Nursing) Common Law ------ court made law based on interpretaion of statutory law (Roe VS Wade) Criminal Law ------ Offense that causes harm to society in general (jail, fine, or both) Civil Law ------ Affects legal rights of individuals or corporations (more likely than not that the incident happened) Tort ------ private wrong against a person or their property by act or omission Intentional Tort ------ Assault & battery, false imprisonment, defamation, breach of confidentiality Unintentional Tort/Negligence ------ person does not act in a resonable matter and causes harm or damage to a person or their property Malpractice ------ Negligent conduct of a professional person Liabiltiy ------ Legal responsibility Breach of Duty ------ Failure to comply with standards of care *** The 6 rights of administering medication ------ 1. Right patient 2. right medication 3. right dose 4. right route 5. right time 6. right documentatin What are "Standards of Practice" ------ that of which the average qualified healthcare provider of the same training and background would provide under the same circumstances What are "Standards of Care" ------ describe outcomes of care, focus on patient Risk Management ------ Process that centers on identification analysis, treatment, and evaluation of real and potential hazards Name strategies to deal with potential hazards and reduce risk of liability ------ 1. informed consent 2. documentation 3. unusual occurance reports 4. Professional liabilty 5. sentinel events Informed consent ------ Without this, IV is assault and battery. Patient must be capable of giving consent, must receive necessary information to make informed decision, must not be coerced Five examples of what should be reported on an Unusual Occurrence Report ------ 1. Patient admitting diagnosis 2. Date/time incident 3. room # 4. name & age 5. type of incident What are the recommended documenting guidelines of IV complaints/discomfort? ------ Date/time, vein specific insertion location, brand model/style of device, gauge & length, infusion solution, gravity or pump, rate of flow, patient comments & teaching When should a medical device be reported to the FDA? ------ when it's faulty What is some common device problems related to IV's? ------ contaminated infusate, skin organisms, device contaminated prior to insertion, cath hub contaminated, hematogeous, thrombus Elements of IV competency: Accountability ------ Nurse must be knowledgable enough to adjust interventions for long term & short term goals Communication ------ Complete data through documentation Collaboration ------ JCAHO demands (consult with other staff) Autonomy ------ Independant decision making List 5 physical occupational hazards and how they can be prevented ------ 1. Needlesticks (guards) 2. Abrasion (watch sharp objects) 3. Contusion (watch sharp objects) 4. Chemical exposure (double glove) 5. latex allergy (avoid exposure) Quality Assurance ------ Policys and procedures that promote better outcomes Quality management ------ Systemic process to ensure positive patient outcomes According to 4723.17 Ohio Revised Code: List 5 procedures a qualified LPN MAY PERFORM ------ 1. Prepare an adult for IV therapy 2. Assemble and maintain equiptment for gravity drip infusion 3. Initiate infusion of IV solution as directed by authorized person 4. Maintain those solutions 5. Regulate peripheral IV List 5 procedures a qualified LPN MAY NOT PERFORM ------ 1. Initiating blood components 2. Initiating or maintaining central venous line 3. Initiating on person under 18 4. Discontinuting any other than peripheral IV 5. Administering meds via IV line Epidemiology ------ Study of diseases injury and causes Antigens ------ Invaders that trigger the immune system What are the primary organs of the immune system? ------ Thymus & Bone marrow What are the secondary organs of the immune system? ------ Lymph nodes, spleen, liver, peyer's patches, appendix, tonsils, adenoids Nonspecific Immune Response ------ present at birth (function without antigen) Specific Immune Response ------ acquired functions (prior to exposure) Active Immunity ------ vaccine or have the disease Passive Immunity ------ use someone elses antibodies (maternal) Signs/symptoms of immunosuppression ------ Frequent infections, more severe, rare infection agents, incomplete response to treatment Colonization ------ Microorganisms replicate without signs and symptoms Carrier ------ a colonized person--- No signs and symptoms Dissemination ------ sheding microorganisms Nosocomial Infection ------ Hospital aquired (after 72 hours) What is the most common microorganism that causes IV related infections? ------ Coagulase Negative Straphylococci Chain of Infection: Causative agent ------ Causes infection Reservoir ------ Place where it grows Portal of Exit ------ Place where it passes from source to host Method of transmission: Direct transmission ------ Touching it.. (Droplet within 3 feet) Indirect transmission ------ indirect object carries the germ 3 types: 1. Vehicle borne: water, food, tourniquet 2. Vector borne: animal, insect 3. Airborne: attach to dust Portal of Entry ------ way it enters the body of host Susceptible Host ------ person at risk for infection What are the three stages of antibiotic use? ------ 1. infection suspected 2. adjusted to microbial agent (ID'd) 3. Patient shows improvement Pharmacoepidemiology ------ benefit and adverse effects to drugs Emporiatirics ------ study of disease in travelers What is infusion phlebitis, include signs and symptoms ------ protective response of vein to irritation, injury, or invasion by disease producing organisms What are 3 factors that cause infusion phlebitis? ------ 1. Irritation 2. Injury 3. Invasion of organisms List 4 of the stategies to prevent/treat infections ------ 1. use recommended precautions 2. wash hands 3. no artificial or long nails 4. use skin antisepsis What is the number one way to prevent infection? ------ wash hands What are the 15 steps in Phillips 15 step method? Precannulation ------ 1.Check order 2. Wash hands 3. Prep equiptment 4. Assess patient 5. Site selection/vein dialation Cannulation ------ 6. Needle selection 7. Glove up 8. Site prep 9. Vein entry 10. Stabilize cath and dress Postcannulation ------ 11. Label 12. Dispose of equipment 13. Educate 14. Calculate rate 15. Documentation What are the two kinds of delivery systems? ------ 1. Glass system 2. Plastic system What type of tubing is needed with the glass system? ------ vented tubing or long straw Coring and how do you prevent it? ------ Spiking through rubber stopper can cause rubber shreds to get into solution, (microscopic) could = emboli List two advantages of the glass system ------ 1. clear 2. good visualization of fluids/contents 3. easy to read level 4. inert, no plastics to react List two disadvantages of glass system ------ 1. Breakage 2. bulky to store 3. hard to spike 4. disposal 5. rigid How do you check the glass system and what are you looking for? ------ 1. Hold up to light, check for rainbows, must be clear, no floaters, no cracks, no flashes of light, expiration date What are three contributing factors that could cause leakage in the plastic system? ------ 1. Length of storage 2. heat 3. agitation 4. blood products 5. fat emulsions 6. certain drugs Does the plastic system need vented tubing or nonvented? ------ doesn't need it but can use either List two advantages of the plastic system ------ Closed system, flexible, light weight, composed of one substance, easy storage List two disadvantages of the plastic system ------ easily punctured, fluid level difficult to determine How do you check the plastic system and what would you be looking for? ------ Inspect outer bag with inner bag (obvious condensation, inner wet?) Squeeze for pin holes. Hold to light look for clarity, no color, no floaters, expiration date, label (right solution) Spike ------ tops drip chamber, sharp tip, do not touch (must stay sterile) Flange ------ plastic guard next to spike, hold behind flange to spike Drop orifice ------ hole opening that determines drop size, determines the drop factor (10,20, or 60 gtt/min) or micro or macro drip Drip chamber ------ connected to tubing (clear- can see to count drops) tubing ------ primary/standard sets 66-100" long, vented or nonvented-- Secondary 32-42" long. Each contains clamps, ports, connectors, filters, available macro or micro Clamps ------ compress tubing to reduce/stop flow (roller, slide, or screw) Injection ports ------ access for admin of meds, membrane covered, use 25 gauge needle for good reseal Backcheck valve ------ Keeps piggyback solution from getting into primary, allows primary to restart when piggyback is finished Hub ------ connects the administration set to the IV catheter, needleless system also called the male luer-lock Final Filter ------ Removes foreign particles, blood set has specific filter, some remove air only Macrodrip tubing ------ 10-20 big drops= 1mL Microdrip tubing ------ 60 tiny drops=1mL What is the INS Standard for changing administrative sets? ------ Change continuous sets every 72 hrs and when suspected of contamination. Primary intermittent sets change every 24 hours and immediately with suspected contamination
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