The five rights of delegation are the right task, right circumstances, right person, right communication, and right supervision/evaluation. The nurse is ultimately responsible for all delegated tasks and must ensure that she delegates the correct task to a person who is qualified and able to perform the task. The right department is not one of the five rights of delegation.
Advocacy is the act of speaking up for one’s vulnerable patients to ensure that their rights and needs are met and protected and that they are receiving safe, appropriate care. This may mean helping the patient to disagree with the physician in an effective manner. Nurses are never to obtain informed consent; they can assist the patient in signing the forms, but it is the responsibility of the physician to counsel the patient. Talking a patient into a treatment decision with which they are not comfortable is not advocacy.
Ensuring that nursing practice is in accordance with the standards of care is the best way that nurses can defend themselves in court if sued for negligence. Following a physician’s instructions blindly is not appropriate, as the physician may have made a mistake. Going against a physician’s instructions is also not appropriate; the nurse should communicate her concerns to the physician and move up the chain of command if she still has serious concerns about his orders. The nurse must only follow the wishes of the patient or the person whom the patient appoints to make decisions for them if they are unable.
Offering false reassurance to the patient is not an effective method of communication and may make patients feel that are not being heard. The nurse is not responsible for obtaining the consent form, especially when it is clear that the patient still has serious concerns. Using difficult medical terminology does not clarify the patient’s concerns. The nurse should inform the physician about the patient’s concerns and have him or her speak with the patient before the patient signs the consent forms.
Case management is the process of assisting patients in obtaining necessary treatments or therapies for optimal outcome. Case management is a very individualized process and is specially tailored toward the needs of an individual patient.
Health maintenance organizations and preferred provider organizations are examples of managed care organizations. Managed care is a system of health care delivery and reimbursement. There is usually a prearranged payment system at which providers agree to be reimbursed.
Nadolol (Corgard) is stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Do not store in the bathroom and keep bottle tightly closed. Option B: Humulin N injection if unopened (not in use) is stored in the fridge and is used until the expiration date, or stored at room temperature and used within 31 days. If opened (in-use), store the vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room temperature (do not refrigerate) and use within 14 days. Keep it in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen. Option C: Urokinase (Kinlytic) is refrigerated at 2–8°C. Option D: Epoetin alfa IV (Epogen) vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do not shake. Protect from light.
Phenylketonuria (PKU) is an inherited disorder that increases the levels of phenylalanine (a building block of proteins) in the blood. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems. The signs and symptoms of PKU vary from mild to severe. The most severe form of this disorder is known as classic PKU. Infants with classic PKU appear normal until they are a few months old. Without treatment, these children develop a permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and hair than unaffected family members and are also likely to have skin disorders such as eczema. The effects of PKU stay with the infant throughout their life (via Genetic Home Reference).
All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse. Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged. Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, use of laxatives or diuretics. Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue.
Excessive pulmonary ventilation decreases hydrogen ion concentration and thus causes respiratory alkalosis. It can become dangerous when it leads to cardiac dysrhythmias caused partly by a decrease in serum potassium levels.
An excess of carbon dioxide (hypercapnia) can cause carbon dioxide narcosis. In this condition, carbon dioxide levels are so high that they no longer stimulate respirations but depress them.
The body compensates by using body fat for energy, producing abnormal amounts of ketone bodies. In an effort to neutralize the ketones and maintain the acid-base balance of the body, plasma bicarbonate is exhausted. This condition can develop in anyone who does not eat an adequate diet and whose body fat must be burned for energy. Symptoms include headache and mental dullness.
In metabolic alkalosis, breathing becomes depressed in an effort to conserve carbon dioxide for combination with water in the blood to raise the blood level of carbonic acid. Symptoms include confusion, dizziness, numbness or tingling of fingers or toes.
The carbonic acid concentration is controlled by the amount of carbon dioxide excreted by the lungs. The bicarbonate concentration is controlled by the kidneys, which selectively retain or excrete bicarbonate in response to the body’s needs.
ABG’s are blood tests that are useful in identifying the cause and extent of the acid-base disturbance and in guiding and monitoring treatment.
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NCLEX-RN Test #5
