Saturday, 7 December 2019

Question Of The Day, Preschooler
Q. A child diagnosed with tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and the respiratory rate increases to 44 breaths/minute. Which of the following actions should the nurse do first?

A. Obtain an order for sedation for the child.
B. Assess for an irregular heart rate and rhythm.
C. Explain to the child that it will only hurt for a short time.
D. Place the child in a knee-to-chest position.

Correct Answer: D

Explanation: The child is experiencing a tet or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from the lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of Fallot. As a result, the blood then entering the systemic circulation has a higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position in the crib, or the mother learns to put the infant over her shoulder while holding the child in a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need a sedative. Once the child is in the position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate the hypoxia.

Friday, 6 December 2019

Question Of The Day, Toddler
Q. After teaching a group of parents about temper tantrums, the nurse knows the teaching has been effective when one of the parents states which of the following?

A. "I will ignore the temper tantrum."
B. "I should pick up the child during the tantrum."
C. "I'll talk to my daughter during the tantrum."
D. "I should put my child in time out."

Correct Answer: A

Explanation: Children who have temper tantrums should be ignored as long as they are safe. They should not receive either positive or negative reinforcement to avoid perpetuating the behavior. Temper tantrums are a toddler's way of achieving independence.

Nursing Career, Nursing Degree, Nursing Responsibilities, Nursing Degree US

Why a Guide on Staffing is So Important

Nursing staffing is an issue that has been forefront lately; in the spring, New York nurses battled for months to establish the state’s first-ever minimum staffing guidelines and Illinois introduced a bill to mandate staffing ratios.  

As McMillan explains, staffing -- which she calls a “complex issue”-- is a long-standing and important focus for the ANA; in their 2019 membership survey, for example, 93% of the respondents identified staffing as an “important” issue, and 72% identified it as “extremely important.” Additionally, she adds that research demonstrates that appropriate nurse staffing leads to better patient outcomes, reduced costs, fewer adverse events, and fewer complications and readmissions.  

She also points out that staffing is a factor in nurse turnover, which costs an average hospital $300,000 for each percent point in RN turnover. If staffing policies don’t adequately meet the needs of nurses, they are more at risk for burnout and as a result, leaving their position, which costs the hospital money for training and recruitment and also leaves patients at higher risk. 

Although the ANA had identified a guide to nursing staffing in its original principles, McMillan notes that an update was necessary, as the original principles were first published in 1999 and updated in 2012. 

ANA’s 5 Principles For Nurse Staffing

The ANA has created free staffing resources including a free eBook, downloadable infographic and staffing webinar on their site. 

Nursing Career, Nursing Degree, Nursing Responsibilities, Nursing Degree US
Chart via ANA website

According to the ANA, the 5 Principles include, 

1. Health Care Consumer: Nurse staffing decisions are based on the number and needs of the patients, families, groups, communities, and populations served.

2. Interprofessional Teams: Optimal care is achieved through individual actions and collaboration with other health care team members. Nurses are full partners in the delivery of safe, quality health care.

3. Workplace Culture: Organizational leaders must create a workplace environment that values nurses as critical members of the health care team.

4. Practice Environment: All nursing care delivery systems must provide the necessary resources to meet each health care consumer's individual needs and the demands of the unit.

5. Evaluation: Organizations must have appropriate nurse staffing plans. All settings need well-developed staffing guidelines with measurable nurse-sensitive outcomes.

Why the ANA Supports Flexible Nursing Staffing

In the updated guidelines on staffing, the ANA supports a flexible approach to nurse staffing, identifying it as beneficial for both patients and nurses. 

“Nurse staffing is more than numbers, and one size does not fit all,” McMillan says. “A flexible approach is associated with improved patient outcomes, including reduced mortality rates, shorter stays, lower readmission rates, and reduced hospital-acquired conditions.”

The organization believes that a flexible approach to nurse staffing allows for “nurse-specific factors,” which can include things like a nurse’s level of experience, knowledge, education, and skillset, as well as patient-specific factors such as acuity and intensity. 

On a practical level, you can see how this might look like when you consider that a minimum staffing ratio might dictate that two nurses be staffed on the floor--but what if both of those nurses are brand-new grads, fresh off of orientation? Technically, the ratio might be met, but will it be the optimum situation for both those nurses and their patients? The ANA’s view is that more nurses who are appropriately matched to patient assignments equal better patient outcomes and improved quality of work-life that will ultimately result in lower rates of nurse burnout, turnover, fatigue, and fatigue-related errors.

According to McMillan, ANA’s staffing principles support all nurses, like the ones performing direct-care and therefore attuned to what patients actually need -- even as those needs can shift on an hourly level -- having a role in nurse staffing decisions. 

With nurses’ input, following the principles would lead to a healthcare organization with the following: 

◉ Nurse-driven staffing guidelines with measurable outcomes

◉ Nurses at all levels having a role in staffing decisions

◉ Staffing needs and assignments taking into account factors such as patient status and nurse competencies 

◉ Flexibility to reassess and adjust staffing during the course of a shift as patients are admitted and discharged

◉ Sufficient training time and resources for new grads and orientees 

◉ Nurse staffing would be referred to as more than numbers, known as “one size does not fit all” 

◉ A focus on flexibility and teamwork to effectively meet the ever-changing needs of patients 

◉ A workplace culture that values nurses as a vital part of the healthcare team

How All Nurses Can Be Involved

To help establish the staffing policies that ANA believes will benefit both patients and staff alike, ANA explains that the organization has been working hard to not only share the updated principles and encourage “a shift in paradigm,” but has also been working on a federal level as well. For example, ANA has been working with federal officials to push for the Centers for Medicare & Medicaid Services to provide Congress with information about how the agency assesses “adequate” staffing levels as part of its 2020 budget request. 

ANA is also working to maintain National Quality Forum endorsement for two nurse staffing measures: skill mix and nursing hours per patient day. McMillan notes that several states already require their hospitals to publicly report these measures, and ANA’s continued advocacy will encourage increased transparency, especially with respect to the Medicare program.

And while federal and state measures are vital for change, the ANA also encourages every nurse who wants to get involved in promoting and implementing flexible nursing staffing policies to take action on a personal level too. 

For instance, McMillan suggests that nurses could start by simply having a conversation with nurse managers and other leaders who are responsible for nurse staffing in your workplace as a first step.

Thursday, 5 December 2019

Question Of The Day, Infant
Q. An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child?

A. Encouraging the infant to hold a bottle
B. Keeping the infant on bed rest to conserve energy
C. Rotating caregivers to provide more stimulation
D. Maintaining a consistent, structured environment

Correct Answer: D

Explanation: The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

Tuesday, 3 December 2019

Q. Crackles heard on lung auscultation indicate which of the following?

A. Cyanosis.
B. Bronchospasm.
C. Airway narrowing.
D. Fluid-filled alveoli.

Correct Answer: D

Explanation: Crackles are auscultated over fluid-filled alveoli. Crackles heard on lung auscultation do not have to be associated with cyanosis. Bronchospasm and airway narrowing generally are associated with wheezing sounds.

Monday, 2 December 2019

Question Of The Day, Medication and I.V. Administration
Q. A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs?

A. Breakthrough bleeding.
B. Severe calf pain.
C. Mild headache.
D. Weight gain of 3 lb.

Correct Answer: B

Explanation: Women who take oral contraceptives are at increased risk for thromboembolic conditions. Severe calf pain needs to be investigated as a potential sign of deep vein thrombosis. Breakthrough bleeding, mild headache, or weight gain may be common benign side effects that accompany oral contraceptive use. Clients may be monitored for these side effects without a change in treatment.

Saturday, 30 November 2019

Question Of The Day, Basic Physical Care
Q. As a nurse helps a client ambulate, the client says, "I had trouble sleeping last night." Which action should the nurse take first?

A. Recommending warm milk or a warm shower at bedtime
B. Gathering more information about the client's sleep problem
C. Determining whether the client is worried about something
D. Finding out whether the client is taking medication that may impede sleep

Correct Answer: B

Explanation: The nurse first should determine what the client means by "trouble sleeping." The nurse lacks sufficient information to recommend warm milk or a warm shower or to make inferences about the cause of the sleep problem, such as worries or medication use.

Friday, 29 November 2019

Q. The nurse is assessing the urine of a client who has had an ileal conduit and notes that the urine is yellow with a moderate amount of mucus. Based on these data, the nurse should?

A. Change the appliance bag.
B. Notify the physician.
C. Obtain a urine specimen for culture.
D. Encourage a high fluid intake.

Correct Answer: D

Explanation: Mucus is secreted by the intestinal segment used to create the conduit and is a normal occurrence. The client should be encouraged to maintain a large fluid intake to help flush the mucus out of the conduit. Because mucus in the urine is expected, it is not necessary to change the appliance bag or to notify the physician. The mucus is not an indication of an infection, so a urine culture is not necessary.




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