• used to protect health care professional from legal liability
• when care is given in an emergency situation
• the care did not recklessly or intentionally cause harm to person needing assistance
• person who provided care did not receive pay
  
• used for persons who stop at an  accident site while not working
  

nonmaleficence

principle of doing no harm

(keep knowledge and skills up to date)

the duty to do good to others and to maintain a balance between benefits and harms

(provide all persons, patients, and the terminally ill with caring attention and information)

the obligation to tell the truth

(refuse to participate in any form of fraud.  give and honst days work every day)

the principle of fairness that is served when an individual is given that which he or she is due, owed, deserves or can legitimately claim.

(treat all patient's fairly regardless of economic or social background)

elements of patient's bill of rights

(patient care partnership)

• intened to ensure that patient's needs were met by the healthcare system
• provides patient's a means of addressing  problems with their care
• encourages them to get well and stay healthy
• replaces in 2003 with "patient care partnership" which discusses patient's right to high quality hospital care, clean and safe environment, involvement in their care, protection of the privacy, help when leaving hospital and help with biling claims

• looking up a client's private medical information when you are not assigned to the patient
• stealing patient's personal info and using it for personal gain
• discussing a patient's health status with a family member
• taking pictures of a patient whether intentional or not

• proof of liability or fraud requires specific elements in order to be claimed for negligence or malpractice
  
• a duty or obligation by law is being done
• a breach of this duty occurred wither by omission or proven
• harm whcih could be physical, emotional, or financial occurred to the patient
• proof that breach of duty caused the said harm
• foreseeability- a link must exist between the nurse's act and the injusry suffered
• causation- must be proved that harm occurred as a direct result of the nurse's failure to follow the standard of care and that the nurse could or should have known that faillure to folow the standard of care could result in harm

• timely report of complications to doctor or charge nurse
• check on client frequently
• address concerns witht the client has and cover the treatment plan
• know and practice the 6 rights of medication administration
• ALWAYS chart what you have done

• the nurse should always follow the institutions policies and procedures to ensure care given is accepted as nursing standard
• nurse must communicate accurately and completely; verbally, in writing and electronically (profession responsibility and accountability are the 2 primary reasons nurses document)
• document care that is given
• in court "if it's not written, it wsn't done" will come out
• nurse should carry own liability insurance

• ANA sets and maintains professional standards
• created a "code of ethics"
• advances the nursing profession by fostering high standards of nursing practice, promoting  rights of  nurses in the workplace, projecting a positive and realistic view of nursing
• lobbies  congress and regulatory agencies on health care issues affecting nurses and the public
• sets a standard for all nurses to ensure quality patient care

• informed consent laws protect patient right to make informed decisions regarding their own care
• doctor or person performing procedure is responsible for explaining the procedure tho the patient: risks, benefits, alternative procedures and potential complications
• nurses often witness the patient's signature.  this nurse is vouching for 2 things: the patient signed and they know they have a signed consent form
• the patient must be at least 18, mentally competent, have received and explanation of procedure, and have consented voluntarily in order to make it legal
• medical POA, a spouse, an adult child or other relative if no one else is available may sign consent

• civil wrong for which a remedy may be obtained
• law where the injured person can sue the wrongdoer for damages
• examples: deny rights of a person, nurse who doesn't comply with public duty or perform a private duty that ends in hurting someone else.  it may be intentional or unintentional s/a malpractice, negligence, assualt, battery, fraud, defamation, false imprisonment or invading privacy

• making a false statement about someone
• may be sued if you cause someone's life to be ruined or end up losing their job

• same as slander but it is through written communication
• if you cause someone's life to be ruined or end up losing their job

• imprisonment that occurs when people are incorrectly led to believe that they cannot leave a place or by physically restraining them from leaving
• as long as the client doesn't have orders (psych pt) they are able to leave if they want. You can't restrain a person if they aren't harming themselves or others.  Even if a pt has a POA that states they do not want them to leave the pt's desires override the POA.  Even if a pt requires restraints you must release them or it may result in false imprisonment charges.

• legal proceeding in which the state prosecutes a person who is charged with a public offense.

• may include sentinel events, medication erros, infectious disease (per CDC or health dept), gun shots, and dog bites

• negligence

• failure to provide the care that a reasonable person would normally perform in the similar situation

• malpractice

•  a professional's wrongful conduct in the discharge of his or her professional duties or failure to meet standards of care for the profession, which in result causes harm to another individual that has entrusted their safety. 

• threat to touch another person in an offnesive manner without that persons permission
• example- a nurse that threatens to give a patient treatment against his/her will

• touching a person without their consent
• example- a nurse who forces treatment against a patients will

• all patient's have the right to privacy and may bring charges against any person who violates this right
• example- nurse who discloses confidential info about a pt or photos of a pt without consent

• when they are given verbally
• illegible handwriting
• when orders are in contradiction to accepted practice

• in instances such as when the patient has a disease that is required by law to report (gonorrhea, flu viruses and such)
• instances when there has been injury such as with gun shot wounds or dog bites

• any person dealing with the use of restraints needs to have training and yearly updates on the proper use of them with regular evaluations
• restraints should only be used for behavioral emergencies
• time and date must be recorded along with the type of restraint, the circumstance and location of the behavioral emergencies, staff involved, length of episode, injuries, other less restrictive methods attempted prior to restraint
• restrained individuals cannot be left alone andrestraints cannot be used as punishment
• restraints used in behavioral emergency must be followed by an order form the physican or licensed independent practioner
• it should follow all state, federal and regulatory agency guidelines
• it should involve notification of a physician or LIP for a written, verbal or telephone order to include the reasonrestraint, the specific type of restraint, the duration of the order and the behavioral criteria for release
• within and hour of initiation of restraint the person must be seen and evaluated by a Dr., LIP or a trained and competnent RN or P.A.
• video monitor cannot replace face to face monitoring
• person is assessed by an RN at time restraints are initiated and at lest hourly thereafter
• R.O.M must be performed q 2hr
• retraints should be dc'd based on the assessmenttht the behavioral criteria are met

• according to nurse practice act you must educate yourself to the signs, symptoms, behaviors, myths and truths which represent substance abuse
• it is important to notify your nurse manager if you suspect  substance abuse even tho it may be hard to do
• educate yourself on your facility policy
• careful documentation on any changes in the person should be made
• do not enable the person
• nurses have a legal, moral and ethical duty to patients, colleagues and nursing profession to take action
• do not ignore poor performance, do not lighten or change the nurse's patient assignment, do not accept excuses, do not allow yourself to be manipulated or fear confronting a nurse it patient safety is in jeopardy

scope of practice issues

(state board of nursing)

• scope of practice is regulated by the state: it defines parameters of nursing practice and gives the authority to regulate the practice of nursing
• laws and rules are stae specific
• board of nursing has the authority to issue and revoke a nursing license
• board sets standards for nursing programs and delineates the scope of practice for RN's, LPN's and APN's
  

• a nurse should provide culturally competent care
• a complex integration of knowledge, attitudes, and skills that enhance cross-cultural communication, and appropriate and effective interactions with their patients
• care is recognized for the specific patient
• care is based on uniqueness of persons culture and their norms/values
• care includes empowerment strategies to facilitate patient decision making in their personal health behavior
• care is provided with sensitivity to cultural uniqueness of the patient

• natural redheads (tend to experience heavier bleeding after delivery)
• uterine atony (relaxation of uterus): this is a mechansim for hemostasis after birth of placenta
• 75% of all PPH is due to uterine atony

• increased vaginal bleeding
• uterine atony
• clots larger than a quarter
• perineal pad saturation in 15 min or less
• return of lochia rubra on it has progressed to serosa or alba
• constant oozinf, trickling, or frank flow of bright red blood from the vagina
• tachycardia and hypotension
• pale, cool, clammy skin with poor turgor and pale mucus mambranes, oliguria
• lab data: hgb/hct decreased, type and cross

• uterine atony
• lacerations
• hematoma
• retained placental fragments
• DIC
• redheads
• med use: general anesthesia, mag sulfate, pitocin
• low platelet count sceondary to PIH

• monitor VS
• assess fundus for height, firmness and position
• perform fundal massage if indicated
• assess maternal hemodynamic staus even with firm uterus
• assess lochia for color, quantity and clots
• assess for signs of bleeding from lacerations, episiotomy site or hematomas
• assess bladder for distention
• maintain or initiate IV fluids to replace fluid volume loss with IV isotonic solutions (LR or NS, albumin or blood products)
• provide O2 @ 2-3L nasal canula
• elevate clients legs to 20-30 degree angle to increase venous return
• meds to use: methergine, cytotec, hemabate

• assess breast consistency
• niplle condition (warm/reddened)
• painful/swollen axillary lymph nodes
• generalized fever
• flulike sx's

• breastfeed
• antibiotic
• supportive bra
• VS with temp
• educate on proper hygeine
• teach breast care
• increase fluids

• flu like sx's
• anorexia and nausea
• pelvic pain
• chills
• fatigue & malaise
• abnormal lab values (sed rate/wbc's elevated)
• loss of appetite
• abnormal lochia
• tachycardia delayed involution
• pain/tenderness of perineum
• backache

• redness
• edema
• ecchymosis/skin discoloration
• approximation of edges
• fever warmth and tenderness

• urgency
• frequency
• dysuria
• urnary retention
• hematuria
• pyuria
• elevated temp
• chills
• suprapubic pain
• malaise
• malodorous cloudy urine

• decreased BP
• increased pulse
• increased respiratory rate
• weak/thready pulse
• oliguria
• rapid shallow breathing
• pallor
• cold extremities

• I & O
• VS
• IV fluids s/a LR
• O2 as necessary
• type and cross
• Pad count
• ABG's
• elevate legs to increase venous return
• central venous pressure or pulmonary artery cath

• a "cut" in the uterus/cervix/vagina after birth
• uterus is firm and contracted
• bright red blood ora steady trickle of blood
• may account for up to 20% of early PPH

• accumulation fo blood in ine area
• often vulvar/vaginal
• occurs d/t injury to a blood vessel during delivery
• bleeding, extension of episiotomy, firm/contracted uterus, pain and difficulty voiding are symptoms

• increased risk of infection
• increased risk for seperation of sutures

• inspect cervix/vagina/perineum/rectum
• assess episiotomy for extension to 3rd or 4th degree laceration
• evaluate lochia
• assess VS and hemodynamic status
• attmept to Id source of bleeding
• assist PCP with repair procedures
• ice packs to treat small hematomas
• larger hematoma >5cm evacuate hematoma
• ligate bleeding vessel if needed
• urniary catheter to prevent straining
• antibiotics
• sitz bath after 24hr
• pain meds
• peri care with warm tap h2o after void/defecaton

• edematous lower extremities
• low to high grade temp
• pain in lower leg
• positive homans sign
• abd pain
• decreased peripheral pulses
• possible pulomnary embolism may result (dyspnea, chest pain, may need blood gases/xray/vq scan)
• increased risk for stroke

• support hosse
• early ambulation
• encourage leg exercises
• with previous DVT monitor for signs of PE
• increase fluid intake
• warm moist compress (no ice)
• measure extremities daily
• monitor for signs of bleeding
• keep vit k (coumadin) and protamine (heparin) available
• monitor pt/ptt

• obesity
• >maternal age
• anesthesia or surgery resulting in venous stasis
• prolonged bedrest
• c-section
• hx dvt
• cigarette smoking
• maternal anemia or diabetes

• crying
• fatigue
• inability to concentrate
• obsessive about not being a good mother
• thoughts of harming baby
• anorexia
• flat effect with baby
• sleep disorders

• uterine stimulant
• controls PPH
• assess uterine tone and vaginal bleeding
• do not administer to hypertensive patients, sepsis, toxemia or renal disease
• monitor client for adverse reactons including htn, nausea, vomiting, and headache

• uterine stimulant
• controls PPH
• assess uterine tone and vaginal bleeding
• not for use in breastfeeding

• uterine stimulant
• controls PPH
• assess uterine tone and vaginal bleeding
• monitor for advers reactions: fever, chills, nausea, vomiting and diarrhea
• contraindicated in: PID, cardiac, renal, hepatic asthma, htn, previous uterine surgery

• uterine stimulant
• promotes uterine contractions
• assess uterine tone and vaginal bleeding
• monitor for adverse reactions: water intoxication s/a lightheadedness, nausea, vomiting, headache, malaise (these reactions can lead to cerebral edema with seizures, coma and death)

• higher chance of aspirating meconium
• dry peelling skin
• overgrown nails
• abundant amounts of hair
• visible creases on palm of hands/bottoms of feet
• sometimes brown/yellow/green stained skin d/t meconium
• might be large and need assistance from forceps/vacuum
• hypoglycemia

• ok in breastfeeding
• antidote is protamine
• given IV or subq
• avoid sitting/crossing legs for long periods of time
• avoid alcohol use
• brush teeth gently
• watch for bleeding gums/nose/easy bruising
• avoid massaging legs

• oral dosing
• vit k is antidote
• no breastfeeding
• monitor for signs of bleeding
• brush teeth gently
• avoid alcohol
• monitor PT

The only real intervention is to educate mom on the importance to avoid any and all alcohol use while pregnant.  Ensure that mom quits drinking ASAP.  Get  mom into an alcohol treatment program early on in her pregnancy.

• phototherapy starts if serum bilirubin is >15mg/dL prior to 48hr of age, >18mg/dL prior to 72hr of age and if it increases >20mg/dL at anytime
• reposition q 2hr to expose all of body
• check lamp energy with a photometer per unit protocol
• observve for complications of phototherapy: bronze discoloration, maculopapular skin rash, pressure areas, dehydration, elevated temperature

• benign
• results from normal newbor physiology of increased bilirubin production d/t breakdown of fetal RBC's and liver immaturity
• signs appear after 24hr of age

• result of an underlying disease
• usually caused by a blood group incompatibility or an infection
• may be result of RBC disorders
• appears before 24hr of age or is persistant after day 7

• weight in 90th percentile or higher
• infant may not be able to descend into pelvic rim properly
• c-section may be necessary
• vaginal birth may dispose infant to bruising or injury s/a broken clavicle, paralysis from trauma to cervical nerves
• infant may score low on gestational age exams with immature reflexes

• facial anomolies
• small lowset eyes
• thin upper lip
• palpebral fissure
• small upper jaw
• short uptorned nose
• smooth philthrum
• prominent epicanthal folds
• growth deficiency
• cns problems
• sga
• microcephaly
• cognitive challenges
• behavior problems
• learning difficulties
• in infancy poor sucking reflex, sleep disturbances, seizures and tremulousness
• babies are very irritable and very inconsolable
• may have heart murmur and skeletal abnormalities

• increased pulse rate
• low blood pressure
• increased respiratory rate
• decreased urine output
• dizziness or decreased LOC

• when a fetus is deprived of oxygen they initially experience tachypnea
• with continued asphyxia respiratory movements cease and the heart rate falls
• in most cases exposure to oxygen and stimulation will induce respirations
• always treat as though it is secondary apnea

• with continued asphyxia the infant develops deep gasping respirations, heart and BP continue to decrease
• respiratons become weaker until they cease
• infant is unresponsive to stimulation
• artificial ventilation with oxygen must be initiated
• infant may have passed into secondary while in utero

• hypoglycemia (irritability, tremors, high pitched cry)
• gestational age
• birth trauma from cephalopelvic disproportion
• congenital anomolies
• hyperbilirubinemia
• meconium aspiration
• electrolyte imbalance
• birth weight
• hypocalcemia (tremors)