Ch 10: Health Care Administration, Hr, Marketing And Pr

Define an Emergency plan… – -A plan for responding to emergency events that should be outlined in organization's policy and procedures manual.
-Must be well defined and well known to all staff.
When can the director of nursing be counted as the charge nurse? – When the licensed beds are under 60
How often are active duty records inventoried? – At least once a year
The Executive Branch- – enforce laws
What major public insurance program was legislated in 1965? – Medicare & Medicaid
Collective Bargaining Laws – The right of employees to unionize. This right is legally protected.
-A complaint must have the signitures of 30% or more of the employees.
Maturity assessment – done to protect young, physically developing athletes, most common methods- circumpubertal, skeletal, dental; tanners five states of maturity assessment STAGE 3 IS MOST CRITICAL
OIG – Office of Inspector General-suppose to protect government against fraud and misuse of medicaid and medicare funds
Trospium – Empty Stomach: At least 1 hour before meals
Define an Emergency plan… – -A plan for responding to emergency events that should be outlined in organization's policy and procedures manual.
-Must be well defined and well known to all staff.
Routes of Med Admin – – oral – easiest and most commonly used; *slower onset*, prolonged effect
-sublingual- under tongue to dissolve, do not swollow, *do not drink* until completely dissolved (exp: Nitroglycerin)
-Buccal- place in mouth against mucous membranes in cheek until dissolves; alternate cheeks to avoid irritation; do not chew or swallow, acts locally on mucosa or systemically via saliva
-Topical-skin and mucous membranes, use gloves and applicators, sterile technique on open wounds, transdermal patch; assess skin and clean, *remove existing patches before applying new*
-Nasal- *sometimes pt prefers to self-admin*, which is much easier when they are capable, have them *blow nose before admin* unless contraindicated; if admin drops into posterior pharynx, tilt pt head back; if admin drops into ethmoid or sphenoid sinus, tilt head back over edge of bed or pillow; for frontal and maxillary sinus tilt head back and toward side to be treated; make sure pt is breathing through mouth when getting nasal drops; make sure pt remains supine 5 min, do not blow nose for several minutes; breath out through the mouth after sniffing med via spray; observe pt for 15-30 min after spray; *overuse can lead to rebound congestion*; if decongestant solution is swallowed, serious systemic effects can develop, especially in kids, should use saline drops if poss, much safer
-*Parenteral*- Intradermal (ID)- injected into dermis, just under epidermis, TB and allergy tests, bevel side up, small bleb forms under skin, insert 5-15 degrees;
-SubQ- injected into tissue just below dermis, rotate injection sites;
-*Intramuscular(IM)* inject into muscle, faster absorption than subq, *SITES*: ventrogluteal, vastus lateralis, deltoid, *ZTRACK* method used to minimize irritation (don't use in deltoid), 1/2" to inch in avg adult up to 3" for obese, 2-5 mL can be absorbed in avg pt, up to 2ml in kids and elderly, small children up to 1mL and infants 0.5 mL, insert at 90 degrees; *aspirate*
-*Intravenous(IV)* inject into vein as mixture within large volume of fluids, by injection of bolus through existing port or by piggyback infusion of solution containing med and iv fluid thru existing line; fast acting; lg volume infusions safest and easiest method of IV admin, standard procedures, concentrations and doses, ready to admin doses avail, check with pharmacist before mixing meds, have another RN verify and watch you during procedure, clean injection port, push med and mix solution by turning gently, attach label, add meds only to new IV bags; PUSH is directly into systemic circ, most dangerous form of med admin because no time to correct errors; volume controlled, piggyback and miniinfusers reduce risk of rapid dose infusion by push, admin meds that are stable for limited time and controls fluid intake
-Epidural- admin into epidural space via catheter; placed by anesthetist or anesthesiologist; typical for surgical procedures
-Intrathecal- catheter placed in subarachnoid space or ventricle of brain, long-term med admin through surgically implanted catheter
-Intraosseous- infusion of med directly into bone marrow, commonly used for infants/toddlers w/poor access to to intravascular space and emergencies when IV access impossible
-Intraperitoneal- meds admin into peritoneal cavity are absorbed into circulation; chemo, insulin and antibiotics
-Intrapleural- syringe and needle or chest tube admin med into pleural space; chemo most common, also meds to resolve pleural effusion (pleurodesis)
-Intraarterial- meds admin into arteries, common in pts w/arterial clots
-Intracardiac- injected directly into cardiac tissue
-Intraarticular- injected into joint
-topical- transdermal disk or patch has systemic effects, *can be left on 12 hrs-7 days*
-Inhalation-local, systemic effects, rapidly absorbed
-Intraocular- med inserted similar to contact lens in pt eye, can remain for up to a week
-opthalmic-drops and ointments, assistance may be needed, avoid instilling directly in eye, don't touch eye with dropper, use in effected eye only; when admin meds that can cause systemic effects, apply gentle pressure to pts nasolacrimal duct for 30-60 seconds to prevent absorption into circulation; if pt needs more than one med in same eye, wait 5 min before admin next med
-EARS – side lying position, straighten ear canal, remain on side 2-3 min, place cottonball; KNOW in *children under three pull pinna down and back*, *adults and children 4 yrs or older pull pinna up and OUTWARD*; if cloudy suspension, shake for 10 seconds; *make sure drops are at room temperature* to prevent vertigo, dizzy or nausea
-Vaginal- suppositories, jellies, creams, body temp melts med, provide privacy and perineal pad to collect drainage
-Rectal- solid suppository in sealed package, store in fridge, assist to Sim's position, *remove wrapper and lube*, have client take slow deep breaths, keep call light in reach
-Inhalers- aerosal spray, mist, powder, penetrates airways and lungs, squeeze and breathe inhaler, spacers sometimes used; respiratory therapy may admin inhalers depending on facility; *have pt rinse mouth after using inhaler*, should shake MDI inhaler w/spacer vigorously 5-6 times before admin to ensure fine particles are aerosolized; do NOT shake DPI or breath activated MDI; have pt take deep breath and exhale to empty lungs and clear airway before inhaling med; have pt inhale deeply and slowly and hold breath for about 10 seconds; *pts should wait 20-30 seconds between inhalations of same med OR 2-5 min between inhalations of diff meds*, or as ordered by dr.; *ALWAYS give bronchodilators before steroids*; instruct pt on proper cleaning of inhaler;
About Nursing profession – Ann Preston organized 1st nursing training in US.
Before WWI nursing had 3 domains: public health, 70% private duty, and hospital.
RN- 2 year degree; 4-5 year BSN;
RNs w/Masters/Doctorals rose 37% since 1980
must pass state licensing; state doesn't enforce continuing competence (no competency exams)
Hospitals main employers
Request for Production – A discovery device used to compel another party to produce documents and other items or evidence important to a lawsuit
About Nursing profession – Ann Preston organized 1st nursing training in US.
Before WWI nursing had 3 domains: public health, 70% private duty, and hospital.
RN- 2 year degree; 4-5 year BSN;
RNs w/Masters/Doctorals rose 37% since 1980
must pass state licensing; state doesn't enforce continuing competence (no competency exams)
Hospitals main employers
health care interventions – designed to improve the quality and efficiency of services provided, and reduce disparities across groups
List the courts in the military court system from lowest to highest. – 1. Courts-Martial
2. Service specific courts of military criminal appeals
3. U.S. Court of Appeals for the Armed Forces
4. U.S. Supreme Court
Implied Formation – At least one term is inferred from the conduct of the parties

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