5 rights of delegation
- right circumstances
- right task
- right person
- right communication
- right supervision
Steps of nursing process
- assessment
- diagnosis
- planning outcomes
- planning interventions
- implementation
- evaluation
prioritizing using Maslow’s
- physiological needs
- safety/security needs
- psychological/social needs
ABC’s
Airway
Breathing
Circulation
SBAR
Situation
Background
Assessment
Recommendation
Therapeutic communication
- client centered
- uses open ended questions
- requires active listening
Evidence-based practice
- best evidence available
- nursing expertise
- patient centered
- values/preferences of the individual
Perfusion & circulation
continuous supply of oxygenated blood through the blood vessels to all body cells
Thermoregulation
process of maintaining a stable body temp
Hyperthermia
Body temp above normal
Hypothermia
body temp below normal
chain of infection
- organism
- reservoir
- portal of exit
- transmission
- portal of entry
- susceptible host
Systemic infection
infection reaches blood or lymph and spreads throughout the body
Peak times
when levels in the blood stream are highest
Trough times
when levels in the blood stream are lowest
Normal vital signs
temp= 98 degrees Fahrenheit pulse= 60-100 bpm respiratory rate= 12-20 breaths per min oxygen sat= 90-100% BP= 100-120/60-80
Objective data
observable & measurable
Airborne precautions
- TB*
- negative pressure room
- N95 mask
Droplet precautions
- Flu, whooping cough, RSV*
- mask
- goggles
- gloves
- gown
Contact precautions
- C-diff*
- gown
- gloves
- mask
Standard precautions
- PPE
- correctly disposing of sharps
- hand hygiene
Local infection
limited to one location within the body
Subjective data
from the clients view such as symptoms and feelings
