Emergency Medical Care and Patient Rights: A Guide for Healthcare Professionals, Exams of Nursing

Download Emergency Medical Care and Patient Rights: A Guide for Healthcare Professionals and more Exams Nursing in PDF only on Docsity!

Fundamentals

Archer Review Crash Course

Welcome!

Please stay muted so that there is no background noise. If you have a question please enter it in the chat and I will respond as quickly as poss We will be taking two 10 minute breaks throughout the course

Introduction

Morgan Taylor, BSN, RN, CCRN Pediatric nurse at heart Units I’ve worked on: PICU PCICU NICU Mother-Baby ED Bone Marrow Transplant Current position: Children’s Resource Unit… a little bit of everything pediatrics! Fun fact: I got married in my backyard this year because….COVID. My niece and ne

Advanced Directives

Advanced Directives & Living Wills

Advanced Directive: a set of instructions someone prepares in advance of ill health that determines his healthc Living Will: one type of advance directive that becomes effective when a person is terminally ill. Legal documents Prepared for when the patient is not able to communicate their own wishes Can specify DNR, Full code, or specific interventions

Good to know...

If summoned, EMTs are legally obligated to provide emergency care to a patient, regardless of advance directive status. If the patient is brought to a hospital, physicians will evaluate the patient and implement the advance directive, if necessary. While some states do honor an advance directive from another state, others do not. For this reason, it is essential for anyone who is moving to a new state (permanently OR temporarily) to update their advance directive to the original state in which they will reside. Advance directives don’t expire. If a new advance directive is created, the most recent one will be honored when presented to medical personnel. If there is no one available to make medical decisions for a patient who appears incapable of doing so, two physicians must evaluate the client and make a recommendation regarding the patient’s decision-making ability.

Medical Power of Attorney

Legal document Designates a specific person to make medical decision for the patient should they b If the patient doesn’t have a MPOA laws vary state by state on who the decision goe

Legal Concepts

Federal Laws to know

● Health Insurance Portability and Accountability Act ○ HIPAA ○ Will discuss further :) ● American Disabilities Act – ADA ○ A civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. ● Emergency Medical Treatment and Active Labor Act – EMTALA ○ Requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay

Terminology

● Tort: A wrongful act or an infringement of a right ● Negligence: Failure to take proper care in doing something. ● Malpractice: Improper, illegal, or negligent professional activity or treatment,. ● Assault: An act, criminal or tortious, that threatens physical harm to a person, whether or not actual harm is done. ● Battery: Unconsented physical contact with another person, even where the contact is not violent but merely menacing or offensive. ● False Imprisonment: The state of being imprisoned without legal authority.

HIPAA

Health Insurance Portability and Ac

Protecting patient health information Specific rules about sharing this information If someone doesn’t NEED the information to do their job, DON’T share it with them. Can share with other health care providers that need it to take care of the patient Can share with their family WITH the patient’s permission.

Documentation

How you can protect your patient’s information

● Turn off your computer screen when not using ● Do not speak about patients in a public place ● Shred personal health information ● NEVER post information about patients on social media ● Don’t use computers that are not secure for PHI ● Don’t send PHI to your personal email ● Don’t open the chart of patients you’re not taking care of.

DO

DON’T

Chart in real time Chart under your name Chart events accurately, without any subjective opinions:. Ex: Pt stated ‘get out of my room you ugly cow’ Delay charting Chart early Char under someone else Chart for someone else Allow someone else to chart under your name Chart your opinion of a patient: Ex: Pt was rude to nurse Change another persons

If it wasn’t documented, it wasn’t done!

● Your charting is a part of the patient’s medical record ● Other healthcare providers as well as the patient can see it ● It can be used in a lawsuit ● It’s subject to review by different agencies: ○ The Joint commission ○ Medicare/Medicaid ○ Quality assurance committees

documentation

SBAR

Background

Why is the patient in the hospital? Chief complaint Diagnosis Pertinent lab values Johnny is a 5 year old with ALL whose Hgb dropped to 6.1 after his last round of chem

Situation

● Identify yourself ● Identify the patient ● Briefly communicate what is going on with the patient “This is Morgan, the nurse taking care of Johnny in room 2 today. I’m calling because his heart increased from the 90’s to the 150’s about 5 minutes after starting his blood transfusion. I am concerned he is having a transfusion reaction.”

Recommendations

What do YOU think is going on What do YOU want to happen Labs to be ordered? Imaging? MD to bedside? Stop an infusion/medication? New order? Changed order? “I suspect Johnny is having a transfusion reaction. I have stopped the transfusion and

Assessment

● What do you think the problem is ● Nursing diagnosis ● Vital signs ● Pertinent clinical assessment findings “His vital signs are: T - 37.8 C, P - 157, BP - 130/94, R - 36, SPO2 - 96%. He appears flushed, diaphoretic, and his having trouble catching his breath”

Positioning

Low Fowler’s

Semi-Fowler’s

Fowler’s

High Fowler’s

Orthopneic Position

Supine

Prone

Right Lateral Recumbent

Left Lateral Recumbent

Trendelenburg

Reverse Trendelenburg

Sims

NCLEX Question

Which of the following interventions is helpful in reducing the effects of GERD? Lie down after eating. Wear a girdle. Elevate the head of the bed on 4-6 inch blocks. Increase fluid intake just before bedtime.

NCLEX Question

You have just received a 4-month-old infant to the Recovery Room after a repair of a Supine with the head of the bed elevated 30 degrees Prone with the head turned to the right Trendelenburg Prone with head elevated slightly

Answer: C

GERD occurs when stomach acid slips into the esophagus. Any position that hinders or slows the movement of food from the stomach should be avoided. C is correct. Patients should be encouraged to elevate the head of the bed to allow food to move out of the stomach before lying flat. A is incorrect. I was lying down after eating causes the movement of food out of the stomach to slow, which could aggravate symptoms. B is incorrect. The compression of the stomach reduces its volume, and those who wear girdles or waist training find that overeating gives them indigestion and heartburn. D is incorrect. When a patient lies in bed shortly after eating or drinking, gravity is not as quickly keeping digestive juices in the stomach. Eating or drinking more than three to four hours before bed reduces the risk of nighttime heartburn.

Break!

Back at...

Answer: A

Postoperative interventions for cleft repair include maintaining an airway free of the accumulation of secretions and monitoring for edema or any narrowing that places the infant at risk for airway compromise. It is imperative that nursing care is focused on the prevention of suture line injury. The correct answer is A. The supine position in the immediate postoperative period allows constant observation of the airway and may also prevent injury to the suture line. B and D are incorrect. The infant should never be positioned in a prone position. C is incorrect. Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins, as well as the external jugular vein. It is not indicated for an infant who has had a cleft repair.

Ethical Concepts

Justice

Fairness To distribute care evenly To administer care fairly To be just and equitable

Beneficence

Doing good Doing the right thing for the patient

Nonmaleficence

Doing no harm No intentional harm No unintentional harm

Accountability

Accepting responsibility for your actions Responsible for your nursing care Responsible for your actions Accept the consequences of your actions

Fidelity

Keeping your promises Faithful True to professional responsibilities

Autonomy

“The nurse accepts the client as a unique person who has the innate right to have t Encouraging patients to make their own decisions No judgement or coercion The patient has the right to refuse any and all treatment

Veracity

Telling the truth Must be completely truthful with your patients You may not withhold any part of the truth from patients This includes when news may upset or cause the patient distress; it does not give yo