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RD Polytechnic BScN 2nd Year Semester 1 > 217 Large Group - Midterm Study Cards > Flashcards

217 Large Group - Midterm Study Cards Flashcards

Midterm Study Cards

1
Q

What is level 1 of levels of care?

A

Home care

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2
Q

What is level 2 of levels of care?

A

Seniors lodge

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3
Q

What is level 3 of levels of care? DSL3, DSL4, 4D?

A

Designated Supportive Living

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4
Q

What is level 5 of levels of care?

A

Long term care

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5
Q

What are nursing assessment for functional abilities?

A

Comprehensive geriatric assessments
• Assessment of physical function
• Screening for delirium, dementia, and depression
• Fall risk screen
• Katz Activities of Daily Living Scale (BADLs)
• Lawton-Brody instrumental activities of daily living (iADLs)
•interRAI
• Assessment of safety in the home
•Driving safety

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6
Q

What does respite care refers to?

A

Care provided for short term relief

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7
Q

What does public health care focus on?

A

Focuses on the needs of an entire population.

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8
Q

What does ACE stand for?

A

acute care of the elderly

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9
Q

Institutional Sector include:

A

Hospitals
Long-term Care Facilities
Psychiatric Facilities
Rehabilitation Centres

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10
Q

Community Sector includes:

A

Public Health
Physician Offices
Community Health Centres (CHCs) and Clinics
Assisted Living
Home Care
Adult Day Support Programs (ADSPs)
Community and Voluntary Agencies
Occupational Health
Hospice and Palliative Care
Parish Nursing

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11
Q

What are the two types of adult day care centres?

A

social
medical

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12
Q

What are clinical manifestations of Parkinson’s Disease?

A
  • Tremor
  • Rigidity
  • Bradykinesia
  • Postural Instability (shuffling gait)
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13
Q

What risk is highly associated with the shuffling gait and pivoting difficulty associated with Parkinson’s disease?

A

Risk of fall

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14
Q

What are skilled home care services?

A

services address the needs of people who are recovering from illness or injury and who have potential for returning to their previous level of functioning

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15
Q

What is non-medical home care?

A

Services that address the needs of people with chronic or declining conditions who do not qualify for skilled home care services.

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16
Q

What are Acute Care for Elders units?

A

Specialized Acute Care for Elders (ACE) units address the complex needs of hospitalized older adults though interprofessional assessments and interventions.

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17
Q

Define functional assessment.

A

Refers to the measurement of a person’s ability to fulfil responsibilities and perform self-care tasks.

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18
Q

What are activities of daily living (ADLs)?

A

Tasks associated with meeting one’s basic needs.

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19
Q

What are instrumental activities of daily living (iADLs)?

A

More complex tasks that are essential to community living situations.

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20
Q

What roles might nurses hold in long term care settings?

A

team leader, nursing supervisor, wellness nurse, director of nursing and assistant director of nursing. Nurses also have very strong roles in teaching nursing assistants (sometimes called health care aides) about the best care for nursing home residents.

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21
Q

What are the 10 competencies identified for nurses within a long term care home?

A
  • Models, teaches and uses effective communication skills, including active listening, giving meaningful feedback and addressing emotional behaviours
  • Implements and role-models person-directed care practices
  • Identifies and addresses barriers to person-directed care
  • Maintains consistency of caregivers for residents
  • Solves complex problems related to resident choice and risk
  • Involves residents, families and all team members in problem-solving, decision-making and planning “
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22
Q

What is function focused care?

A

A functional assessment approach focuses on improved functioning in daily life, regardless of diagnosis. In geriatric clinical settings, there is increasing emphasis on using functional assessments as a core component of function-focused care, which is a rehabilitative approach to preventing functional decline and improving an older adult’s level of functioning.

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23
Q

What is included in an assessment for ADLs?

A
  • bathing
  • dressing
  • mouth care
  • hair care
  • dietary intake
  • transfer mobility
  • ambulation
  • bed mobility and
  • bladder and bowel elimination.
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24
Q

What are included in an assessment of iADLs?

A

IADL include:

  • shopping
  • laundry
  • transportation
  • house-keeping
  • meal preparation
  • money management
  • medication management and
  • the use of telephone.
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25
Q

What does a comprehensive geriatric assessment address?

A
  • medical
  • psychosocial
  • cognitive
  • and functional components
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26
Q

What area of weakness does the RAI-MDS 2.0 have?

A

Weak in its ability to measure mood or behavioural problems.

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27
Q

Which version of the RAI-MDS does Canada use?

A

2.0

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28
Q

What normal changes associated with aging can alter driving ability?

A

Vision, musculoskeletal function and central and autonomic nervous systems can affect driving abilities even in healthy older adults.

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29
Q

Who can be a case manager for inter-RAI assessment tool?

A
  • RN
  • Physical therapist
  • Occupational therapist
  • Social worker
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30
Q

What is involved in Level 1 - Home Care?

A

This is for seniors who live fairly independently, but need some assistance with their daily routine. They can be living on their own or in a seniors residence.

Individuals are responsible for arranging and managing any home care and support services they require. Some services are paid for by Alberta Health Services, while others are paid for out of the senior’s pocket.

Home care is paid for by AHS only if the senior is assessed by an AHS case manager, who determines what the client needs. The case manager is a Registered Nurse (RN). In-home services can include nursing and rehabilitation, and personal support services like housekeeping, bathing or grooming assistance.

If the senior wants additional services that AHS doesn’t cover, they can hire extra help from a private home care provider, but they must pay for it themselves. Otherwise, their family and friends are expected to help out.

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31
Q

What is involved in Level 2 - Supportive Living – including various seniors’ facilities, retirement centres and lodges

A

Supportive living combines housing and “hospitality services” (meals, housekeeping, laundry etc.). The facility operators are responsible for coordinating and arranging hospitality services and may also coordinate or provide personal care and other support services.

Seniors who are fairly independent, with or without the help of home care, are a good fit for this level.

Publicly-funded home care can, if a need is assessed by the AHS case manager, provide in-home professional support services such as nursing and rehabilitation, and personal support services like housekeeping, meal preparation or bathing. This will either be provided for by home-care workers or staff employed by the facility.

Many of these facilities offer a wide variety of services – but there will be a charge for any that are not paid for by AHS. Typically, full meal service will be available in a central dining area, as will housekeeping, laundry and linen services, transport services, as well as various organized social activities.

Seniors in level 2 can also arrange and manage their own care and be responsible for decisions about day-to-day activities. They can manage some but not all of their daily tasks independently. All or most personal services can be scheduled. A basic set of services/supports is required. They may require some assistance or encouragement to participate in social and rehabilitation programs.

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32
Q

What is involved in Level 3 – Assisted Living – DSL 3 (Designated Supportive Living 3)

A

Seniors with health needs that, in the case manager’s assessment, require 24 hour personal care and support are eligible for placement in a Designated Supportive Living 3 (DSL3) facility. Seniors in DSL3 have higher care needs that cannot be scheduled, but can still use a call system to get the help they need. They should not be considered a risk to themselves or others and should be medically stable.

Health Care Aides are on site 24 hours every day to provide support and personal care. Again, only those services assessed as required by the AHS Case Manager will be paid for by AHS. All other services will be the resident’s responsibility. Seniors will have to provide their own furniture and household items, medications and medical supplies, and equipment. Residents pay an accommodation fee to cover the costs of providing accommodations and services like meals, housekeeping and building maintenance.

DSL3 spaces are contracted by AHS within lodges and other supportive living facilities, or within higher-care facilities (SL4). SL3 residents must not need complete meal assistance, two-person transfers (in and out of bed, the bath etc.) or toileting assistance.

Seniors in level 3 may need assistance in making some decisions about day-to-day activities. – and will require help with many daily tasks. The need for unscheduled personal assistance is infrequent, but can come up occasionally. Increased assistance is required for participation in social and rehabilitation programs.

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33
Q

What is involved in Level 4 – Enhanced Assisted Living – DSL 4 and DSL 4D (Designated Supportive Living 4 and 4 Dementia)

A

Seniors with complex medical needs that require 24-houron-site professional nursing and high levels of personal care and support (in the case manager’s assessment) are eligible for placement in a Designated Supportive Living 4 or 4 Dementia facility. These spaces may be stand-alone or be separate areas within other seniors’ facilities.

Care is managed on-site by a licensed practical nurse (LPN) under the direction of a home care registered nurse (RN) and delivered by health care aides.

Residents may require complete meal assistance (including tube feeding), mechanical lift transfers, medication administration, total assistance to move from place to place and total assistance to manage toileting. Residents in the secure dementia units may suffer from moderate to severe dementia.

Again, only those services assessed as required by the AHS case manager will be paid for by AHS. All other services will be the resident’s responsibility. Seniors will have to provide their own furniture and household items, medications and medical supplies, and equipment.

Residents pay an accommodation fee to cover their room rental and services like meals, housekeeping and building maintenance.

Seniors in level 4 will need assistance in making decisions about day-to-day activities. They will also require assistance with most or all daily tasks. The need for unscheduled personal assistance is frequent. They will require enhanced assistance for participation on social and rehabilitation programs.

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34
Q

What is involved in Level 5 – Facility Living - Long Term Care (Nursing Homes and Auxiliary Hospitals)?

A

To be placed in a nursing home or auxiliary hospital, seniors are assessed by AHS as having serious, chronic and/or unpredictable medical conditions that require access to registered nurses able to respond immediately on a 24 hour basis. They may have unpredictable behaviours that put themselves or others at risk.

Residents in long term care pay an accommodation fee to cover the costs of providing accommodations and services like meals, housekeeping and building maintenance. Health services in long-term care are publicly-funded and provided through Alberta Health Services.

Medical/surgical supplies, medications and medically necessary transportation are paid for by the facility not the resident, nor do the residents need their own furniture.

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35
Q

What categories are assessed as part of the MDS?

A
  • Hearing, speech, and vision
  • Cognitive patterns
  • Mood
  • Interview
  • Preferences for customary routine, activities, community setting
  • Functional status
  • Bladder and bowel
  • Active disease diagnosis
  • Health conditions
  • Swallowing/nutrition status
  • Oral/dental status
  • Skin conditions
  • Medications
  • Special treatments and procedures
  • Restraints
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36
Q

List 3 age-related MSK changes.

A
  • Degenerative changes of bones, muscles, joints, and connective tissue
  • Slowed reaction time
  • Diminished bone mass density(osteopenia and osteoporosis)
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37
Q

What are the negative functional consequences of MSK changes related to aging?

A
  • Decreased muscle strength and endurance
  • Increased difficulty performing ADLs
  • Increased risk for falls and fractures
  • Increased fear of falling
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38
Q

What puts older adults at risk?

A
  • Decreased weight-bearing activities
  • Decreased calcium and vitamin D
  • Tobacco smoking
  • Pathological conditions
  • Adverse medication effects
  • Environmental factors
  • Gait changes
  • Decreased sensory function
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39
Q

What is sarcopenia?

A

Loss of muscle mass, strength, and ensurance

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40
Q

What happens to muscles as we age?

A
  • Decreased size and number of muscle fibres
  • Loss of motor neurons
  • Replacement of muscle tissue by connective tissue and, eventually, by fat tissue
  • Deterioration of muscle cell membranes and a subsequent escape of fluid and potassium
  • Diminished protein synthesis
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41
Q

How is bone density scored?

A

T-score

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42
Q

What is a normal T-score?

A

-1 and above

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43
Q

What is the diagnosis when the T-score is between 1 and 2.5?

A

Osteopenia

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44
Q

What do you call a fracture that occurs with little or no trauma?

A

fragility fracture

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45
Q

What are the factors that increase the risk of developing osteoporosis?

A
  • Age 65 or 70 years or older for women and men, respectively
  • Family history of osteoporosis or osteoporotic fracture
  • Low calcium intake, both past and current
  • Vitamin D deficiency
  • Lack of weight-bearing activity
  • Hormonal deficiency from age-related changes or pathologic conditions
  • Cigarette smoking
  • Excessive alcohol intake
  • Pathologic conditions (e.g., hypogonadism, hyperparathyroidism, thyrotoxicosis, malabsorption, low gastric acid, pre- or post-solid organ transplant, low gastric acid)
  • Medications (e.g., corticosteroids, anticonvulsants, anticoagulants, aromatase inhibitors, cancer chemotherapeutic agents) “
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46
Q

What are additional features that increase the risk of fragility fractures?

A
  • Postmenopausal status for women, age 75 years or older for men, younger age in the presence of other risk factors
  • Female sex
  • Multiple risk factors for osteoporosis
  • Previous fragility fracture, especially in combination with undertreatment of osteoporosis
  • Family history of hip fracture
  • Body mass index (BMI) less than 18.5 kg/m 2
  • Current or previous use of oral or systemic glucocorticoids
  • Falling
  • Rheumatoid arthritis
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47
Q

What is an ischemic stroke/cerebrovascular accident (CVA)?

A

Sudden loss of function resulting from disruption of the blood supply to a part of the brain.

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48
Q

When does recovery for an ischemic stroke plateau?

A

Usually around 6 months

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49
Q

When does functional recovery for a hemorrhagic stroke plateau?

A

Slower than ischemic strokes, usually plateauing at about 18 months

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50
Q

What kicks off the ischemic cascade?

A

When cerebral blood flow decreases to less than 25 ml per 100 g of blood per minute.

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51
Q

True or false: The interRAI is a mix of objective and subjective data?

A

True

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52
Q

How often is the interRAI completed?

A

Usually completed every 3 months or when there is a decline in any area.

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53
Q

What specific things do nurses do in Supportive Living and/or LTC?

A
  • catheters
  • med admin
  • case management *
  • care planning **
  • coordination of care and referrals
  • staffing rations and scheduling
  • patient and family education
  • physical assessment and recommendations
  • coordination of bed placements
  • coordination of interdiscoplinary team
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54
Q

Where can home care be delivered?

A

Anywhere that someone lives.

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55
Q

Which services will be paid for by AHS?

A

Only services assessed and required will be paid for by AHS. Need to be firm of scope of services identification.

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56
Q

What are goals of home and community care?

A
  • Support families
  • Promote independence
  • Health maintenance or improvement
  • Help people stay at or return home
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57
Q

What is the scope of functional assessment?

A

From full function to disability.

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58
Q

What does the term ‘function’ refer to?

A

Positive or neutral interaction between a person’s health condition and ability to perform social or physical activities

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59
Q

What does the term disability refer to?

A

Negative aspects to a person’s health condition and social or physical limitation. Impairment refers to the physical abnormality that underlies these limitations and is caused by some type of disease process.

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60
Q

What does ISBARR stand for and what is its purpose?

A

Identity, Situation, Background, Assessment, Recommendation, Repetition

It is a communication tool that enables efficient, comprehensive and clear exchange of information.

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61
Q

What are the strongest predictors of falls in hospitals, nursing homes and community settings?

A

A history of falls and the use of walking aids

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62
Q

What pathological conditions and functional impairments are risk factors for falls?

A
  • Age-related conditions (e.g., nocturia, osteoporosis, gait changes, postural hypotension, sensory deficits)
  • Cardiovascular diseases (e.g., arrhythmias or myocardial infarction)
  • Respiratory diseases (e.g., chronic obstructive pulmonary disease [COPD])
  • Neurologic disorders (e.g., parkinsonism, cerebrovascular accident [CVA])
  • Metabolic disturbances (e.g., dehydration, electrolyte imbalances)
  • Musculoskeletal problems (e.g., osteoarthritis)
  • Transient ischemic attack (TIA)
  • Vision impairments (e.g., cataracts, glaucoma, macular degeneration)
  • Cognitive impairments (e.g., dementia, confusion)
  • Psychosocial factors (e.g., depression, anxiety, agitation)
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63
Q

What environmental factors lead to risk of falls?

A
  • Inadequate lighting
  • Lack of handrails on stairs
  • Slippery floors
  • Throw rugs
  • Clutter, cords or other objects in the walking path
  • Unfamiliar environments
  • Highly polished floors
  • Improper height of beds, chairs or toilets
  • Physical restraints
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64
Q

In what two rooms in institutional settings are falls most common for older adults?

A

Bathroom and bedroom

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65
Q

How long does the acute period for a stroke last?

A

24 to 72 hours

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66
Q

What are possible complications for a patient who has had a stroke?

A
  • Deconditioning and other MSK problems
  • Swallowing difficulties
  • Bowel and bladder dysfunction
  • Inability to perform self-care
  • Skin breakdowns
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67
Q

What is considered hypoglycemic re: blood glucose readings?

A

BG < 70 mg/dL

(severe < 50 mg/dL)

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68
Q

What range is euglycemia?

A

BG 70 - 140 mg/dL (pre- and post prandial)

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69
Q

What range is considered hyperglycemic?

A

Post prandial BG > 140 mg/dL

severe: > 180 mg/dL

70
Q

What are signs and symptoms of hyperglycemia?

A
  • Reduced cognition
  • Tremors
  • Diaphoresis
  • Weakness
  • Hunger
  • Headache
  • Irritability
  • Seizure
71
Q

What are signs and symptoms of hyperglycemia?

A
  • Polyuria
  • Polydipsia
  • Dehydration
  • Fatigue
  • Fruity odor to breath
  • Kussmaul breathing
  • Weight loss
  • Hunger
  • Poor wound healing
72
Q

What type of diabetes has insulin deficiency?

A

Type 1

73
Q

What type of diabetes has:

  • Insulin deficiency
  • Insulin resistance
  • Deficient hormone signalling
A

Type 2

74
Q

What are risk factors for Type 1 diabetes?

A
  • Family history
  • Environment
  • Age
75
Q

What can be provided in home care?

A
  • Case management
  • Medication admin
  • infusion therapy (end of life, antibiotic therapy)
  • Respite
  • Adult day home
  • Transition beds
  • Hospice
  • Palliative care
  • Light homemaking
76
Q

What are the potential care professionals that are providing care/involved in home care (perhaps part of the coordination?)

A
  • Nurse
  • LPN
  • HCA
  • Nurse practitioner/physician
  • Dietician
  • respiratory therapist
  • speech language pathologist
  • pharmacist
  • physio/OT
  • social worker
  • mental health services
  • Client and family are active members of the care team
77
Q

What needs to be in place to receive publicly-funded home care?

A
  • A referral and follow ups (be reassessed to ensure still meets criteria)
78
Q

How does someone become a home care client?

A
  • Through discharge planning
  • with a referral
  • Professional assessment completed and certain criteria met
  • An individual can seek home care through private funding as well
79
Q

Which home services will be paid for by AHS?

A

Those that have been assessed and are deemed required.

80
Q

What are the goals of home care?

A
  • Support families
  • Promote independence
  • Health maintenance or improvement
  • Help people stay at or return home
  • Helps to reduce health care costs
81
Q

What does AADL stand for?

A

Alberta Aids to Daily Living

(provides supplies to a client; e.g. ostomy, diabetic supplies)

82
Q

What does RAAPID stand for?

A

Referral, Access, Advice, Placement, Information & Destination

(coordinates the flow of services across sites); want to get patients to facilities closest to their home (repatriation)

83
Q

What does CCC stand for?

A

Continuing Care Centre

84
Q

What does SL stand for related to home care?

A

Supportive Living

85
Q

What does DSL stand for?

A

designated supportive living

86
Q

What does LTC stand for?

A

long term care

87
Q

What does interRai stand for?

A

inter Resident Assessment Instrument

88
Q

What are the interrelated concepts with functional ability?

A
  • Development, cognition, and culture
  • Nutrition, sensory perception, mobility and gas exchange
  • Sexuality and elimination
  • Family dynamics, stress and coping, perfusion
89
Q

What is functional performance?

A

Actual activities they are able to perform. What ADLs they actually perform.

90
Q

What is a functional ability.

A

Actual, potential capacity to perform a functional ability that would be normally expected and appropriate for the person’s age and developmental stage

91
Q

What are two main types of functional assessments?

A

Self-reported and performance based (where we witness them performing the tasks)

92
Q

What aspects are assessed in the Katz Index of Independence in Activities of Daily Living

A
  • Bathing
  • Dressing
  • Toileting
  • Transferring
  • Continence
  • Feeding
93
Q

What aspects are assessed in the Lawton-Brody IADL scale?

A
  • Ability to use the telephone
  • Shopping
  • Food preparation
  • Housekeeping
  • Laundry
  • Mode of transportation
  • Responsibility for own medication
  • Ability to handle finances
94
Q

Describe how the nerves are affected structurally (anatomy) and functionally (physiology) with MS.

A
  • Demyelinating disease that impacts the CNS. It is immune mediated and impacts the ability for the transmission of nerve impulses to occur, effectively, due to the impact on myelin on axons.
  • Autoimmune (The precise cause is unknown)
  • Progressive
95
Q

What are the clinical manifestations of MS? (consider the different types of MS).

A
  • Neurons become demyelinated causing a disrupted flow of information throughout the brain and spinal cord.resulting in visual impairments, spasticity, incontinence, cognitive dysfunction, and paralysis.
  • Signs and symptoms depend on the location of the lesion - decreased strength, foot drop, changes is vision, bowel and urine incontinence or retention, constipation, fatigue, paresthesia, change in balance and coordination, decreased mobility - use of cane/walker/wheelchair
  • Four types of clinical manifestations (RR, primary progressive, secondary progressive, and progressive relapsing)
96
Q

How could living with MS impact your functional ability?

A
  • Fatigue can impact ability to complete ADLs and iADLs
  • Mobility impacts can affect ability to perform ADLs and iADLs
  • Medications can impair functional abilities
  • Depending upon the type of MS, functional ability impairments may ebb and flow; therefore supports/interventions may be temporary or permanent (in the case of progressive)
  • Loss of memory/cognitive impacts can impair
  • Impacts to vision and speech can be detrimental to ADLs and iADLs
  • Sexual dysfunction
  • Diplopia and scotoma (and other visual impacts due to lesions on the optic nerve)
  • Secondary Complications - UTI’s, constipation, pressure ulcers, contractive deformities, dependent pedal edema, pneumonia, reactive depression, osteoporosis
97
Q

Describe how the nerves are affected structurally (anatomy) and functionally (physiology) with PD.

A
  • Destruction of dopaminergic neuronal cells in substantia nigra in basal ganglia, affecting neural pathways (imbalance of Ach and dopamine neurotransmitters in corpus striatum) leading to tremors, rigidity, bradykinesia and postural changes.
98
Q

What are the clinical manifestations of Parkinson’s?

A
  • Gradual onset, symptoms progress slowly; prolonged course
  • Tremor (present when seated, increases with activity), muscular rigidity, bradykinesia, postural instability, slowness of movement, tremors may affect mainly distal limb segments
  • Postural instability and gait problems
  • Face becomes emotionless
  • Dysphagia ( be aware of aspiration)
  • Correlated with depression, dementia, sleep disturbance, sexual dysfunction, cognitive/perceptual(auditory/visual hallucinations) & memory deficits, uncontrolled excessive sweating, paroxysmal flushing, orthostatic hypotension, gastric/urinary retention, constipation, dysphonia, hypokinesia
99
Q

How could living with Parkinson’s impact your functional ability?

A
  • Fall risk increase
  • Route movements may become impaired
  • Impact on posture and gait
  • Dysphonia may result which can impact ability to verbally communicate
  • Dyskinesia (perhaps a hazard to themselves and others as you cannot control movements)
  • Bradykinesia can impact the ability to complete both IADLs and Basic ADLs
  • Parkinson medications can provide additional challenges due to side effects
  • Surgical management, such as stereotactic procedures, can provide additional secondary impacts that can impact ADLs
100
Q

How might you receive shift change reports? (in what format?)

A
  • written (rarely)
  • in person oral
  • recording
101
Q

What circumstances can make change of shift reports more prone to errors?

A
  • Emergencies at time of shift change
  • distractions
  • Stress
  • Fatigue
102
Q

What are some non-modifiable risk factors for stroke?

A
  • Advanced age
  • Gender
  • Race
103
Q

What are some modifiable risk factors for stroke?

A
  • Hypertension
  • Atrial fibrillation
  • Hyperlipidemia
  • Obesity
  • Smoking
  • Diabetes
  • Smoking
  • Obesity
  • Sedentary lifestyle
  • Sleep apnea
  • Migraine
104
Q

Identify education requirements for patients with falls and hip fractures.

A
  • Participate in activities that promote improving musculoskeletal strength, balance and endurance
  • Wearing good non-slip footwear
  • Using mobility assistive devices
  • Nutritional needs (calcium and vitamin D)
  • Assess medications that may impact vitamin absorption
  • Activity
  • Pain management
  • Weight management
  • Fear of falling and addressing
  • Smoking cessation and limit alcohol intake
  • Fall prevention programs
105
Q

What is the number 1 cause of hip fractures in seniors?

A

Falls (90% of hip fractures result from falls)

106
Q

In which ways could an ischemic stroke impact mobility status of older adults?

A
  • Affects ADLs
  • Depending on the location of the stroke it could impact gait, coordination, balance, and mobility
  • Could cause unilateral hemiplegia or weakness
  • Increased muscle tone (stiffness or contracture) or have a low muscle tone (floppy) which reduces muscle movement and automatic response of the muscles
  • Ataxia - muscle movements are poorly timed and coordinated
  • Dyspraxia - unable to coordinate, perform, or carry out specific movement
107
Q

List some priority assessments for a person having experienced an ischemic stroke.

A
  • ABCs (airway, breathing, circulation)
  • Neurological Assessment GCS
  • Grip strength, leg strength, facial symmetry, arm drift, ability to verbalize (speak)
  • Vital Signs (every 15 minutes)
  • MSK
108
Q

List some nursing diagnoses that may be appropriate related to mobility for a person having experienced an ischemic stroke.

A
  • Impaired physical mobility related to ischemic stroke as evidenced by loss of balance and brain injury
  • Disturbed sensory perception related to ischemic stroke as evidenced by brain injury and altered sensory reception/transmission.
  • Risk for falls related to previous ischemic stroke.
  • Unsteady gait related to ischemic stroke as evidenced by right sided weakness, and use of cane.
109
Q

What lab tests are associated with an assessment for diabetes?

A
  • Blood sugar test (fasting glucose and AIC)
  • Antibody test (C-peptide)
  • Lipids
  • Renal function
  • CRP
110
Q

What macrovascular complication are there for diabetes?

A

Artherosclerosis

  • Coronary artery disease
  • Myocardial infarction
  • Cerebrovascular disease
111
Q

What microvascular complications exist for diabetes?

A

• Nephropathy • Neuropathy • Retinopathy

112
Q

What is the ABCDES of macrovascular complications?

A

A – A1C

B – Blood Pressure

C – Cholesterol

D – Drugs to protect your heart

E – Exercise + Eating

S – Stop Smoking +manage Stress

113
Q

What is involved in the prevention and treatment for nephropathy?

A
  • Blood sugar control
  • Blood pressure control
  • Blockade of renin angiotensin aldosterone system (RAAS)
114
Q

How do you screen for nephropathy?

A
  • ACR
  • eGFR
115
Q

What is involved in prevention for neuropathy?

A
  • Blood sugar control
116
Q

How do you screen for neuropathy?

A
  • 10g monofilament
  • Foot Assessment!
117
Q

What is involved in prevention of retinopathy?

A
  • Blood sugar control
  • Regular comprehensive dilated eye exam
118
Q

What are non-pharmacologic treatments for type 2 diabetes?

A

Physical activity

  • Blood sugar control
  • Weight management
  • Other health benefits

Nutrition

  • Dietitian referral
  • Blood sugar control
  • Weight management
119
Q

What is the definition of a nursing diagnosis?

A

A clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community.”

120
Q

What is the NCSBN definition of the nursing process?

A

A scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation, and evaluation.

121
Q

What are the QSEN competencies for generalist nursing practice?

A
  • Client-centered care
  • Teamwork and collaboration
  • Safety
  • Evidence-based practice
  • Informatics
  • Quality improvement
122
Q

What is involved in the client-centered care QSEN competency?

A
123
Q

What is involved in the QSEN competency of teamwork and collaboration?

A
124
Q

What is involved in the QSEN competency of safety?

A
125
Q

What is involved in the QSEN competency of evidence-based practice?

A
126
Q

What is involved in the QSEN competency of informatics?

A
127
Q

What is involved in the QSEN competency of quality improvement?

A
128
Q

What is involved in effective problem solving?

A
  • Obtaining information, and then using the information, in addition to what they already know, to find a solution
  • Involves evaluating the solution over time to be sure that it is still effective
  • May need to try different options if the problem recurs
129
Q

What is involved in effective decision making?

A
  • A product of critical thinking that focuses on problem resolution
  • Following a set of criteria helps you make a well-reasoned decision
  • Involves moving back and forth between steps when all criteria are considered
  • Leads to informed conclusions that are supported by evidence and reason
  • Involves choosing a course of action from several options
  • Is the action for actually making the decision
  • Not a linear process, moving back-and-forth amongst steps
  • Leads to an informed decision supported by evidence and reason
  • Is approached thoughtfully
130
Q

What is clinical judgment?

A

“the observed outcome of critical thinking and decision making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern , and generated the best possible evidence-based solutions in order to deliver safe client care” (NCSBN, 2018 as cited by Ignatavicius, 2021).

131
Q

Describe the difference between intuitive thinking and analytical thinking.

A

The analytical style of thinking is step-wise and logical. It usually attempts to break a problem or issue into its constituent parts both to understand and to address or solve it. … On the other hand, the intuitive style of thinking is driven more by gut-feel and confidence derived from experience.

132
Q

What is the difference between problem-solving and decision making?

A
  • Problem solving is the journey, decision-making is the destination
  • Problem solving is the more analytical of the two
  • Decision-making is the outcome of problem-solving (problem solving is a necessary piece of making a decision)
133
Q

What are components of critical thinking?

A
  • think of it as important thinking
  • thinking in a controlled manner
  • testing assumptions
  • careful evaluation of information
  • evaluating evidence
  • uncover values and reasons
134
Q

What is clinical reasoning?

A
  • Clinical thinking but within a clinical context
  • the process that the nurse uses to arrive at a clinical judgment
135
Q

What are the components of clinical judgment?

A

Clinical judgment = critical thinking + clinical reasoning

136
Q

Define critical judgment.

A

An interpretation or conclusion about a person’s needs or concerns (based on both critical thinking and clinical reasoning)

137
Q

What are ten strategies for developing clinical judgment?

A
  • Keep references handy
  • Apply nursing process
  • Think ahead, think-in-action , think back (reflect)
  • Follow policies, procedures, and standards of care; understand reasons behind them
  • Learn to set priorities
  • Never perform actions if you don ’t know why
  • If in doubt, get help
  • Seek out clinical experiences
  • Remember the importance of caring (build relationships)
  • When planning nursing care, consider time required for direct and indirect care interventions
138
Q

What are three different types of thinking that may be used as part of clinical judgment?

A
  • Analytical thinking (logic and process based)
  • Intuitive thinking (gut based on past experiences)
  • Narrative thinking (trying to make sense of the experience)
139
Q

What steps does the nursing process consist of?

A
  • Assessment
  • Analysis
  • Planning
  • Implementation
  • Evaluation

(formerly ADPIE - diagnosis less a focus and analysis more of a focus)

140
Q

True or false: there is an increased emphasis on the use of NANDA in the nursing program

A

False

141
Q

What are the steps of problem solving?

A
  • Problem
  • More info
  • Use info
  • Find solution
  • Evaluate
  • Different option
142
Q

True or false: Decision making is not a linear process.

A

True

143
Q

What is involved in the strategy of ‘keeping references handy’?

A
  • Cheat sheets
  • Apps
  • Policies and procedures
  • Know the terminology/abbreviations
  • Lab values
  • Assessment cheat sheet (ORA cards)
  • Facility algorithms
  • Normal range of vitals
  • Evidence-based resources to use
  • Problem specific facts
144
Q

What does the strategy of ‘apply the nursing process’ involved?

A
  • Assess before you act
  • Assess pain yourself before giving meds
  • Review resident chart
145
Q

What are the major goals of clinical judgment?

A
  • Promote health and prevent illness, injury, disability and complications
  • Teach people to do the same
146
Q

What are requirements of clinical reasoning and clinical judgment?

A
  • Manage your resources
  • Promote wellbeing in diverse populations with complex issues
147
Q

What are some components to assessing things/assumptions systematically and comprehensively?

A
  • How will you approach?
  • Primary source (your own assessment)
  • Information collected/Secondary sources (patient record, drug reference)
  • Grouping data (think concept map)
  • Recognize gaps in data (and search for info to fill in the gaps)
148
Q

For diabetes assessment, what aspects of the history should you include in assessment?

A
  • Social history
  • Family history
  • Medical history (including medications)
149
Q

What symptom is often a trigger to get tested in Type 2 diabetes?

A

Slow wound healing

150
Q

What are the various types of occular complications with diabetes?

A
  • Retinopathy
  • Cataracts
  • Lens changes
  • Extraocular muscle palsy
  • Glaucoma
151
Q

What is the main cause of glaucoma?

A

Your eye constantly makes aqueous humor. As new aqueous flows into your eye, the same amount should drain out. The fluid drains out through an area called the drainage angle. This process keeps pressure in the eye (called intraocular pressure or IOP) stable. But if the drainage angle is not working properly, fluid builds up. Pressure inside the eye rises, damaging the optic nerve.

The optic nerve is made of more than a million tiny nerve fibers. It is like an electric cable made up of many small wires. As these nerve fibers die, you will develop blind spots in your vision. You may not notice these blind spots until most of your optic nerve fibers have died. If all of the fibers die, you will become blind.

152
Q

What is open angle glaucoma?

A

This is the most common type of glaucoma. It happens gradually, where the eye does not drain fluid as well as it should (like a clogged drain). As a result, eye pressure builds and starts to damage the optic nerve. This type of glaucoma is painless and causes no vision changes at first.

153
Q

Define retinopathy.

A

Deterioration of the small blood vessels that nourish the retina.

154
Q

What is angle closure glaucoma?

A

This type happens when someone’s iris is very close to the drainage angle in their eye. The iris can end up blocking the drainage angle. You can think of it like a piece of paper sliding over a sink drain. When the drainage angle gets completely blocked, eye pressure rises very quickly. This is called an acute attack. It is a true eye emergency, and you should call your ophthalmologist right away or you might go blind.

155
Q

Who is at risk for glaucoma?

A
  • are over age 40
  • have family members with glaucoma
  • are of African, Hispanic, or Asian heritage
  • have high eye pressure
  • are farsighted or nearsighted
  • have had an eye injury
  • use long-term steroid medications
  • have corneas that are thin in the center
  • have thinning of the optic nerve
  • have diabetes, migraines, high blood pressure, poor blood circulation or other health problems affecting the whole body
156
Q

Define diabetic peripheral neuropathy.

A

DPN is a long-term complication of diabetes. Exposure to high blood glucose levels over an extended period of time causes damage to the peripheral nerves – the nerves that go to the arms, hands, legs, and feet

157
Q

What are risk factors of diabetic peripheral neuropathy?

A

Although DPN can occur in many places in the body, the most common symptoms of DPN are abnormal sensations in the toes and feet, including: • sharp, shooting pains • burning • tingling • a feeling of being pricked with pins • throbbing • numbness (not able to properly feel pain, heat, or cold)

158
Q

What is the main clinical manifestation of open angle glaucoma?

A

Loss of peripheral vision

159
Q

Open-angle glaucoma symptoms

A

With open-angle glaucoma, there are no warning signs or obvious symptoms in the early stages. As the disease progresses, blind spots develop in your peripheral (side) vision.

Most people with open-angle glaucoma do not notice any change in their vision until the damage is quite severe. This is why glaucoma is called the “silent thief of sight.” Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.

160
Q

Angle-closure glaucoma symptoms

A

People at risk for angle-closure glaucoma usually show no symptoms before an attack. Some early symptoms of an attack may include blurred vision, halos, mild headaches or eye pain. People with these symptoms should be checked by their ophthalmologist as soon as possible. An attack of angle-closure glaucoma includes the following:

  • severe pain in the eye or forehead
  • redness of the eye
  • decreased vision or blurred vision
  • seeing rainbows or halos
  • headache
  • nausea
  • vomiting
161
Q

What is the most common type of glaucoma?

A

Open angle

162
Q

What are some factors that affect hearing?

A
  • Exposure to noise
  • Impacted cerumen
  • Ototoxic medication
  • Disease processes (otosclerosis)
163
Q

Define conductive hearing loss.

A

Results from abnormalities of the external and middle ear that interfere with sound conduction

164
Q

Define sensironeural hearing loss

A

“is caused by abnormalities of the sensory and neural structures of the inner ear, which usually are age related or noise induced.”

165
Q

What is presbycusis?

A

“the sensorineural hearing loss associated with an age-related degeneration of the auditory structures”

166
Q

Effects of hearing loss on overall wellness and quality of life of older adults:

A
  • Diminished physical and cognitive function
  • Functional decline
  • Perception of quality of life as excellent: only 39% of subjects with hearing loss compared with 68% of those without
  • A source of loneliness, isolation, diminished participation in social activities
  • Increased self-perception of poor social skills, which can result in diminished self-esteem
  • Increased prevalence of depression
  • Decreased autonomy
  • Increased dependence on other
167
Q

Nursing assessment of hearing is aimed at identifying the following:

A
  • Factors that interfere with hearing wellness
  • Actual hearing deficit
  • The impact of any hearing deficits on safety and quality of life
  • Opportunities for improving hearing wellness
  • Barriers to implementing interventions
168
Q

Nursing interventions for hearing loss:

A
  • Preventing and alleviating impacted cerumen
  • The initial intervention is to ensure that a medical evaluation is performed by a qualified professional to identify treatable causes of the hearing loss.
  • Sound amplification (e.g. hearing aids and assistive listening devices)
  • Auditory rehabilitation
  • Surgical interventions
168
Q

Nursing interventions for hearing loss:

A
  • Preventing and alleviating impacted cerumen
  • The initial intervention is to ensure that a medical evaluation is performed by a qualified professional to identify treatable causes of the hearing loss.
  • Sound amplification (e.g. hearing aids and assistive listening devices)
  • Auditory rehabilitation
  • Surgical interventions
169
Q

What are some techniques for communicating with hearing impaired people?

A
  • Stand or sit directly in front of, and close to, the person.
  • Talk toward the better ear, but make sure your lips can be seen.
  • Make sure the person pays attention and looks at your face.
  • Address the person by name, pause and then begin talking.
  • Speak distinctly, slowly and directly to the person.
  • Do not exaggerate lip movements because this will interfere with lip reading.
  • Avoid chewing gum, covering your mouth or turning your head away.
  • If the person does not understand, repeat the message by using different words.
  • Avoid or eliminate any background noise.
  • Avoid raising the volume of your voice; rather, try to lower the tone while still speaking in a moderately loud voice.
  • Keep all instructions simple and ask for feedback to assess what the person heard.
  • Avoid questions that elicit simple yes or no answers.
  • Keep sentences short.
  • Use body language that is congruent with what you are trying to communicate.
  • Demonstrate what you are saying.
  • Use large-print written communication and pictures to supplement verbal communication.
  • Make sure only one person talks at a time; arrange for one-on-one communication whenever possible.
  • If the hearing-impaired person normally wears eyeglasses to improve vision, make sure the eyeglasses are clean.
  • Provide adequate lighting so that the person can see your lips; avoid settings in which there is glare behind or around you.

RD Polytechnic BScN 2nd Year Semester 1 (9 decks)

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