CH Final exam Flashcards
Goals of Home Health Care
Maximize the client’s level of independence
Minimize the effects of existing disabilities
Decrease rehospitalization
Prevent or delay institutionalization
Types of Home Health Agencies
Voluntary nonprofit agencies, Hospital-based agencies, For-profit proprietary agencies
Medicare Home Health Eligibility
- The type of services and frequency provided must be reasonable and necessary
- The client must be homebound (must be confined to home except for visits to the physician, outpatient dialysis, adult day center, or outpatient chemotherapy and radiation therapy)
- The plan of care must be entered onto specific Medicare forms
- The client must be in need of a skilled service (restrictively defined and include select aspects of nursing, physical therapy, or speech therapy)
- Services must be intermittent and part-time
Home Health Nursing Practice
Locating the client
First step in making a home visit is finding where the client lives
Directions in rural areas may be unclear
Clients may not be staying in households designated in nurse’s paperwork
Always remember that you are a guest in the home
Respect and attentive listening are the foundation for establishing trust
Nurse must take into account the spiritual, cultural, developmental, environmental realms of the client
The client is the driver of care
nurse challenges in the home
infection control, medication safety, risk of falling, technology at home, nurse safety
advantages to home health nursing
Lower cost comparted to inpatient care Quality of life Self-care and independence, easier access to loved ones Restoration of family control of care Provide the nurse with information Improve access Positive outcomes
disadvantages to home health nursing
Nurse safety, travel time, less efficient
Family’s privacy
Distractions
Clients may be resistant or fearful of the intimacy of home visits
Out-of-pocket expenses
Negative impacts on family members
Components of a Home Visit
pre-visit, home visit, conclusion of visit, documentation
disaster
An event that causes human suffering and demands more resources than are available in the community
Can be naturally occurring, man-made, or a combination of both, such as a natural disaster causing technical failures
types of disasters
human made and natural made
examples of human made
Structural collapse, fire, or explosions
Terrorist attacks such as bombing, riots, and bioterrorism
Mass transportation accidents
example of natural disasters
Avalanches Blizzards Communicable disease epidemics Cyclones Droughts Earthquakes Floods Forest fires
level 1 of disaster
Massive disaster that involves significant damage and results in a presidential disaster declaration, with major federal involvement and full engagement of federal, regional, and national resources
level 2 of disaster
Moderate disaster that is likely to result in a presidential declaration of an emergency, with moderate federal assistance
level 3 of disaster
Minor disaster that involves a minimal level of damage, but could result in a presidential declaration of emergency
phases of disaster management
disaster prevention (mitigation), Disaster Preparedness, Disaster Response, and disaster recovery
Disaster Prevention (Mitigation)
Actions or measures that can prevent the occurrence of a disaster or reduce the damaging effects of a disaster
Disaster Preparedness
Disaster preparedness occurs at the national, state, and local levels.
Personal and family preparedness are crucial components of disaster preparedness, as is professional preparedness for individuals employed in civil service and health care.
This level of management includes preparedness for natural or man-made disasters.
Role of the Nurse: Disaster Planning
Develop a disaster response plan based on the most probable disaster threats
Identify the community disaster warning system, and communication center, and learning how to access it
Identify the community’s first responders’ disaster plan
Make a list of agencies that are available for the varying levels of disaster management at the local, state and national levels
Define the nursing roles in first-, second-, and third-level triage
Identify the specific roles of personnel involved in disaster response and the chain of command
Locate all equipment and supplies needed for disaster management, including hazmat suits, infectious control items, medical supplies, food, and potable (drinkable) water. Detail a plan to replenish this regularly.
Check equipment (including evacuation vehicles) regularly to ensure proper operation
Evaluate the efficiency, response time, and safety of disaster drills, mass casualty drills, and disaster plans
Role of the Nurse: Disaster Response
In the health care agency setting, if a disaster occurs, the agency disaster preparedness plan (emergency response plan) is activated immediately, and the nurse responds by following the directions identified in the plan
In the community setting, if the nurse is the first responder to a disaster, the nurse cares for the victims by attending to the victims with life-threatening problems first; when rescue workers arrive at the scene, immediate plans for triage should begin
Perform triage and direct those affected, coordinating evacuation, quarantine, and opening of shelters
Triaging involves identifying those who have serious verses minor injuries, prioritizing care of victims, and transferring those requiring immediate attention to medical facilities
Triage color
Red: (Emergent) Priority 1 (Highest)
Victims with life-threatening injures and need for immediate attention and continuous evaluation; high probability for survival when stabilized
Yellow: (Urgent) Priority 2
Victims who require treatment and whose injuries have complications that are not life-threatening, provided they are treated within 30 minutes to 2 hours
Green (Nonurgent) Priority 3
Victims with local injuries who do not have immediate complications and who can wait at least 2 hours for medical treatment
Black:
Expired or soon will be deceased; would not benefit from any care because of the severity of injuries
Role of the Nurse: Disaster Recovery
Make home visits and reassess the health care needs of the affected population.
Provide and coordinate are in shelters.
Provide stress counseling and assessing for PTSD or delayed stress reactions, and making referrals for psychological treatment.
Category A Biological Agents
High priority agents include organisms that pose a risk to national security because they:
Can be easily disseminated or transmitted from person to person
Result in high mortality rates and have the potential for major public health impact
Might cause public panic or social disruption
Require special action for public health preparedness
Category A Biological Agents examples
Anthrax Botulism Plague Smallpox Tularemia Viral hemorrhagic fevers (e.g., Ebola)
Category B Biological Agents
Second highest priority agents include those that:
Are moderately easy to disseminate
Result in moderate morbidity rates and low mortality rates
Require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance
Category B Biological Agents examples
Brucellosis
Clostridium perfringens toxin
Food safety threats (Salmonella, E. coli O157:H7)
Q fever
Ricin toxin
Typhus fever
Viral encephalitis (Eastern Equine Encephalitis, Western Equine Encephalitis)
Water safety threats (Vibrio cholera, Cryptosporidium parvum)
Category C Biological Agents
Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of:
Availability
Ease of production and dissemination
Potential for high morbidity and mortality rates and major health impact
Category C Biological Agents examples
Nipah virus
Hantavirus
________ - __________ ____________ is the setting that provides the necessary care allowing the greatest personal freedom.
Least-restrictive environment
The nurse’s role in acute mental health and community-based mental health care settings are similar in that the nurse provides client education and administers medications in both settings.
true
Benefits of group therapy include
Sharing common feelings and concerns
Sharing stories and experiences
Diminishing feelings of isolation
Creating a community of healing and restoration
Providing a more cost-effective environment than that of individual therapy
termination phase of group development
Marks the end of the group sessions; group members discuss termination issues; group leader summarizes work of the group and individual contributions.
orientation phase of group development
Focus is to define the purpose and goals of the group; group leader sets a tone of respect, trust, and confidentiality among members; members get to know one another and the group leader; discussion about termination to prepare group members.
working phase of group development
Focus is to promote problem-solving skills to facilitate behavior change; group leader uses therapeutic communication to encourage group work toward meeting goals; group members may take informal roles within the group.
Assisting the client with cessation of smoking is an example of what type of mental health therapeutic strategy?
health promotion and health maintenance
Providing incentives to promote client self-care is an example of what type of mental health therapeutic strategy?
promotion of self care activities
Administering prescribed medications; monitoring for adverse effects of medications is an example of what type of mental health therapeutic strategy?
psychobiological interventions
Coordinating holistic care to include medical, mental health, and social services is an example of what type of mental health therapeutic strategy?
case management
___________ - ___________ ___________ is care consisting of:
- dignity and respect
- information sharing
- patient and family participation and
- collaboration in policy and program development
patient centered care
_________ _________ is a small version of the larger society; provides an opportunity for the patient to test new behaviors and increases the patient’s ability to interact adaptively when discharged to the community.
milieu therapy
goals of acute mental health treatment?
Prevention of client harming self or others
Stabilizing mental health crises
Return of clients to community care settings
transference
Feelings that the client has developed toward the therapist in relation to similar feelings toward significant persons in the client’s early childhood
Countertransference
when the nurse displaces onto the patient feelings that are a response to people in the nurse’s past. Strong positive or strong negative reactions to a patient may be indicative of countertransference
Cognitive-Behavioral Therapy (CBT)
Based on the underlying theoretical principle that feelings and behaviors are largely determined by the way people think about the world and their place in it
Dialectical Behavioral Therapy (DBT)
A cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior
Focuses on gradual behavior changes and provides acceptance and validation for these clients
A nursing student new to psychiatric mental health nursing asks a peer what resource he can use to determine which symptoms are present in a specific psychiatric disorder. The best answer would be:
A. Nursing Interventions Classification (NIC)
B. DSM-5
C. Nursing Outcomes Classification (NOC)
D. NANDA-I Nursing Diagnoses
B
Providing a safe environment for patients, orienting the patient to the physical setting, and assisting the patient to participate in appropriate activities are all part of: A. Milieu therapy B. Cognitive-behavioral therapy C. Behavior therapy D. Interpersonal psychotherapy
A
A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention?
A. Assist the client with systemic desensitization therapy.
B. Teach the client appropriate coping mechanisms.
C. Assess the client or comorbid health conditions.
D. Monitor the client for adverse effects of medications.
D
persecution
Feels singled out for harm by others (e.g., being hunted down by the FBI)
Grandeur
Believes that he/she is all powerful and important, like a god
somatic delusions
Believes that his/her body is changing in an unusual way, such as growing a third arm
religiosity
Is obsessed with religious beliefs
magical thinking
Believes his/her actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes him/her invisible to others
thought withdrawal
Believes that her thoughts have been removed from her mind by an outside agency
thought insertion
Believes that others’ thoughts are being inserted into his mind
thought broadcasting
Believes that her thoughts are heard by others
ideas of reference
Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about him
antipsychotics appropriate for positive symptoms
First-Generation (Conventional, Typical) Antipsychotics
antipsychotics appropriate for positive and negative symptoms
Second-Generation/Atypical Antipsychotics
antipsychotics appropriate for positive, negative, and cognitive symptoms
Third-Generation Antipsychotics
medication examples for second generation/atypical antipsychotics
risperidone, clozapine, quetiapine, olanzapine, ziprasidone
medication examples for first generation (Conventional, Typical) Antipsychotics
haloperidol, chlorpromazine, loxapine, fluphenazine
medication examples for Third-Generation Antipsychotics
aripiprazole
A nurse is caring for a patient who has schizoaffective disorder. What type of statement indicates the client is experiencing depersonalization?
“I am no one, and everyone is me”
Signs and symptoms that precede the acute, fully manifested signs and symptoms of disease; occurs in 80-90% of persons with schizophrenia before the emergence of frank psychosis
prodromal phase of schizophrenia
Periods of florid positive symptoms (hallucinations, delusions) as well as negative symptoms (apathy, withdrawal, lack of motivation) and cognitive symptoms
acute phase of schizophrenia
Period in which acute symptoms, particularly the positive symptoms, decrease in severity
stabilization phase of schizophrenia
Period in which symptoms are in remission, although their might be milder persistent symptoms (residual symptoms)
maintenance phase of schizophrenia
Period in which symptoms are in remission, although their might be milder persistent symptoms (residual symptoms)
maintenance phase of schizophrenia
flight of ideas
Associative looseness - A flight of ideas occurs when a person rapidly shifts between conversation topics, making his or her speech challenging or even impossible to follow
neologisms
Made-up words that have meaning only to the client
echolalia
Client repeats the words spoken to him
clang association
meaningless rhyming of works, often in a forceful manner
word salad
Words jumbled together with little meaning or significance to the listener
positive symptoms of schizophrenia
hallucinations, delusions, disorganized speech (associative looseness), bizarre behavior
flat affect, poverty of thought or speech (alogia), lack of motivation (avolition), inability to experience pleasure or joy (anhedonia)
negative symptoms of schizophrenia
inattention, impaired memory, poor problem-solving skills, poor decision-making skills
cognitive symptoms of schizophrenia
depression, anxiety, demoralization, suicidality, hopelessness
affective/mood symptoms of schizophrenia
true or false: Prevention of relapse with schizophrenia can be more important than the risk of side effects from medications because most side effects are reversible, while the consequences of relapse may be irreversible.
true
agranulocytosis
Serious blood-dyscrasia; can be fatal; most often seen with clozapine; requires frequent monitoring of WBC
extrapyramidal symptoms
Acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia
neuroleptic malignant syndrome
Life-threatening medical emergency; sudden high fever, blood pressure fluctuations, diaphoresis, tachycardia, muscle rigidity, drooling, decreased LOC, tachypnea, coma
nurses role in milieu Therapy
Orienting the client to the physical setting
Identifying rules and boundaries of the setting
Ensuring a safe environment for the client
Assisting the client to participate in appropriate activities
