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NURS level 3 > chronic ill test 1 > Flashcards

chronic ill test 1 Flashcards

1
Q

nursing process

A

assessment, diagnosis, planning, intervention, evaluation

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2
Q

nursing management responsibilities

A 
Staffing
Employee satisfaction
Safety and quality
Customer satisfaction
Budgeting
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3
Q

nursing management skills

A

strong ability to make clinical decisions, priority setting, Organizational skills, Use of resources, Time management, Team communication

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4
Q

car coordination includes

A

patient, provider, and care team

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5
Q

care coordination

A

Care coordination is a necessary foundation to achieving the “triple aim” of health reform

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6
Q

“triple aim” of health reform

A
  1. Improved patient experience of care (quality, access, and reliability).
  2. Improved population health.
  3. Per capita cost control.
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7
Q

what happens if care coordination isn’t involved

A 
Increased cost
Potential drug interactions
Increased medical error
Unnecessary duplication of tests and services 
Unnecessary patient and family distress
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8
Q

what is chronic illness defined as

A

Persisting longer than 6 months
Irreversible
Affects functioning in one or more systems

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9
Q

top chronic illnesses in the US

A
  1. Heart disease
  2. Cancer
  3. Chronic lung disease
  4. Stroke
  5. Alzheimer’s Disease
  6. Diabetes
  7. CKD
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10
Q

how many adults in the US have a chronic illness

A

6 in 10 adults in the US have a chronic disease

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11
Q

how many adults in the US have 2 or more chronic illness

A

4 in 10

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12
Q

cost of chronic disease

A

90% of the nation’s $3.3 trillion in annual health care expenditures are for people with chronic health conditions

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13
Q

causes of chronic disease

A

tobacco use, poor nutrition, lack of exercise, excessive alcohol use

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14
Q

1 complication of chronic disease

A

depression

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15
Q

other complications of chronic disease

A

spiritual distress, fear, anxiety, and powerlessness

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16
Q

spiritual patients and chronic illness

A

Spiritual patients are able to find meaning and purpose in life and are better able to cope with and accept their chronic illness

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17
Q

chronic illness management

A

1: Prevention of exacerbations - Imperative for patient’s to know the signs and symptoms of the onset of a crisis!

Carrying out prescribed treatment regimen
Controlling symptoms
CHF+ diuretics
Adjusting to changes in the course of disease
Prevent social isolation

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18
Q

management of Patient with COPD

A

maintenance medications are key + sick day plan

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19
Q

management of patient with CHF

A

daily monitoring of weight and sodium intake + medication compliance

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20
Q

8 phases of chronic illness

A
  1. onset
  2. stable
  3. acute
  4. comeback
  5. crisis
  6. unstable
  7. downward
  8. dying
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21
Q

phase 1 onset of chronic illness

A

Signs and symptoms are present

Disease diagnosed

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22
Q

phase 2 onset of chronic illness

A

Illness course and symptoms controlled by treatment regimen

Person maintains everyday activities

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23
Q

phase 3 onset of chronic illness

A

Active illness with severe and unrelieved symptoms or complications
Hospitalization may be required for management

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24
Q

phase 4 onset of chronic illness

A

Gradual return to an acceptable way of life

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25
Q

phase 5 onset of chronic illness

A

Life-threatening situation occurs

Emergency services are necessary

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26
Q

phase 6 onset of chronic illness

A

Unable to keep symptoms under control

Life becomes disrupted while patient works to regain stability

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27
Q

phase 7 onset of chronic illness

A

Gradual and progressive deterioration in physical or mental status
Continuous alterations in everyday life activities

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28
Q

phase 8 onset of chronic illness

A

Patient relinquishes everyday life interests and activities, let go, and die peacefully
Immediate weeks, days, hours preceding death

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29
Q

examples of community resources for chronic ill patients

A 
School
Government
Non-profits
Faith-based organizations
All of these resources keep chronically ill patients supported, involved and active!
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30
Q

how are health systems involved in the chronic care model

A

Develop agreements that facilitate care coordination
Promote effective improvement strategies
Encourage open and systematic handling of errors and quality problems to improve care

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31
Q

Self-Management Support

A

Empower and prepare patients to manage their health care by Encouraging patients to set goals, identifying barriers and challenges, and monitoring their own conditions

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32
Q

Delivery System Design

A

Assure effective, efficient care and self-management support through Regular, proactive planned visits to maintain optimal health

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33
Q

decision Support

A

Promote care consistent with scientific data and patient preferences

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34
Q

Clinical Information Systems

A

Organize data to facilitate efficient and effective care

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35
Q

Upon initial diagnosis of a chronic illness, patient’s can experience the

A

5 stages of grief

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36
Q

5 stages of grief

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
    Some stages may be revisited, and others may not be experienced at all
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37
Q

transition between stages is an

A

ebb and flow, NOT a progression

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38
Q

life alterations during a chronic disease

A

Behavioral and emotional changes
Impact on body image
Impact on self-concept
Impact on family

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39
Q

life alteration reactions depend on

A
  1. The nature of the illness
  2. Patient’s attitude
  3. The reaction of others
  4. Variables of illness behavior
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40
Q

illness behavior

A

how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the resources in the health care system

41
Q

5 phases of adjustment in body image:

A
  1. Shock
  2. Withdrawal
    * Withdrawal is an adaptive coping mechanism that helps the patient adjust
  3. Acknowledgment
  4. Acceptance
  5. Rehabilitation
42
Q

self concept

A

a mental self-image of strengths and weaknesses in all aspects of personality

43
Q

As a nurse, if you observe changes in patient’s self-concept then

A

develop a care plan to help them adjust to the changes resulting from the illness

44
Q

what is common in impact on families

A

Role reversal is common

45
Q

impact on family dynamics

A

Parent becomes ill the family activities and decision making often come to a halt
The nurse views the WHOLE family to develop a care plan to help the family regain the maximal level of functioning and well-being

46
Q

The Americans with Disabilities Act of 1990 (ADA)

A

makes it unlawful to discriminate in employment against a qualified individual with a disability
Employer must provide reasonable accommodation as needed

47
Q

Work place issues vary greatly depending

A

on the level of disability and the job being performed

48
Q

Having a chronic illness increases the likelihood of using

A

sick leave/time off

49
Q

1 chronic disease in the US

A

cardiovascular disease (CVD)

50
Q

risk factors of CVD

A

smoking, high cholesterol, poor diet, drinking, inactivity, high blood pressure, family history, employment, housing, air pollution

51
Q

management of HTN

A
  • At both stage 1 and stage 2: encourage nonpharmacological therapies
  • Dietary modifications (DASH diet)
  • Physical activity
  • Smoking cessation
  • Pharmacologic treatment + medication compliance
52
Q

DASH diet

A

grains, vegetables, fruits, unsalted nuts, lean meats, dried fruit, low fat plain yogurt

53
Q

Pharmacologic treatment goal

A

SBP < 130mmHg

54
Q

Strategies for Management of CAD

A

Medication compliance (statins)
Smoking cessation
Appropriate management of other chronic disease such as HTN and DM

55
Q

Strategies for Management of MI/ACS

A

Timely medical intervention
ACS: door to balloon = 90 minutes
After intervention - CARDIAC REHAB

56
Q

CVD: Prevention of Complications

A

Regular appointments with PCP and cardiologist
Medication compliance
Close monitoring of signs and symptoms
CHF: weight gain monitoring

57
Q

Typical factors involved in worsening HF

A

Noncompliance with salt restriction
Pulmonary infectious processes
Use of antiarrhythmic agents
Arrhythmias

58
Q

Early symptoms of HF exacerbations: (Think, FACES)

A 
F= Fatigue
A = Activity limitation 
C = Chest congestion/cough
E = edema
S = shortness of breath
59
Q

COPD: Strategies for Management

60
Q

OPD: Prevention of Complications

A

Medication compliance
Regular appointments with pulmonologist and PCP
Health promotion
pulmonary rehabilitation

61
Q

Early signs of COPD exacerbations

A

Worsening dyspnea from baseline and/or ADLs
Increased sputum
Change in the color of sputum
Increased oxygen requirement

62
Q

COPD Exacerbation Treatment

A

“Sick Day Plan”

Antibiotic + Oral corticosteroid

63
Q

CKD: Strategies for Management

A

Medication: Anti-hypertensive
Correction of extracellular fluid volume overload or deficit
Renal replacement therapy: dialysis
Nutritional therapy

64
Q

CKD: Prevention of Complications

A

BP control, hyperglycemia control, adequate nutrition, primary prevention - vaccinations

65
Q

DM: Strategies for Management

A 
Monitoring blood glucose
Oral medications
nutritional therapy
exercise
insulin
66
Q

DM: Acute Complications

A 
Diabetic Ketoacidosis (DKA) – caused by a profound deficiency of insulin. Characterized by:
1. Hyperglycemia
2. Ketosis
3. Acidosis
4. Dehydration
Hyperosmolar Hyperglycemic Syndrome (HHS) – characterized by: 
1. Severe hyperglycemia
2. Osmotic diuresis
3. Extracellular fluid depletion
67
Q

DM: Prevention of Other Complications

A

Educate patient on signs and symptoms and treatment of hypoglycemia

68
Q

signs and symptoms and treatment of hypoglycemia

A

Cold, clammy skin
Faintness, dizziness
Hypoglycemia treatment = “rule of 15”

69
Q

“rule of 15”

A
  1. Eat or drink 15g of quick-acting carb (4-6oz regular soda or OJ, 5-8 LifeSavers)
  2. Wait 15 min and check blood glucose
  3. If blood glucose is still <70mg/DL, have patient repeat treatment of 15g of carbs
70
Q

(HIV)

A

retrovirus that causes immunosuppression

71
Q

AIDS

A

a diagnosis that is made when an HIV-infected patient meets criteria established by the CDC. These criteria occur when the immune system becomes severely compromised

72
Q

HIV/AIDS – Strategies for Management and Prevention of Complications

A

adhering to Drug therapy, adopt a healthy lifestyle, protect others from HIV

73
Q

1 cancer in men

A

prostate cancer

74
Q

1 cancer in women

A

breast cancer

75
Q

As RNs, we have an essential role in the prevention and early detection of cancer. How?

A

By eliminating risk factors

76
Q

Colonoscopy screening guidelines (CDC, 2019)

A

Adults age 50-75
Every 10 years, unless abnormal
Adults >75 should ask their PCP

77
Q

Cancer – Strategies for Prevention

A

RNs should educate patients to…
Limit alcohol use
Get regular physical activity
Obtain regular colorectal screenings
Get regular mammography screening and Pap tests
Avoid cigarette smoking and other tobacco use
Use sunscreen with a sun protection factor of 15 or higher
Practice healthy dietary habits, such as reducing fat consumption, avoiding processed meats, and increasing fruit and vegetable consumption

78
Q

Seven Warning Signs of Cancer

A

C – change in bowel or bladder habits
A – a sore that does not heal
U – unusual bleeding or discharge from any body orifice
T – thickening or a lump in the breast or elsewhere
I – indigestion or difficulty in swallowing
O – obvious change in a wart or mole
N – nagging cough or hoarseness

79
Q

primary cause of death in the patient with cancer

A

infection so Educate pt on signs and symptoms of infection

80
Q

Overall goals for the patient with RA

A
  1. Satisfactory pain management
  2. Minimal loss of function of affected joints
  3. Participate in planning and implementing therapeutic regimen
  4. Maintain a positive self image
  5. Perform self-care to the maximum amount possible
81
Q

medication for RA

A

DMARDs

NSAIDs

82
Q

RA – Nursing Management and Prevention of Complications

A 
ambulatory care - alternate rest and activity
joint protection
heat and cold therapy
exercise
psychological support
83
Q

MS support

A

Onset usually between 20 and 50 years of age

Women are affected 2-3x more than men

84
Q

Overall goals for the patient with MS

A
  1. Maximize neuromuscular function
  2. Maintain independence in ADLs for as long as possible
  3. Manage disabling fatigue
  4. Optimize psychosocial well-being
  5. Adjust to the illness
  6. Reduce factors that precipitate exacerbations (e.g. infection, trauma, stress, change in climate)
85
Q

Medications for MS

A

Disease-modifying drugs (Avonex)
Corticosteroids (for managing exacerbations)
Muscle relaxants (symptom management)

86
Q

exercise for MS

A

Decreases spasticity, increases coordination, and retrains unaffected muscles to substitute for impaired ones - water exercise is beneficial

87
Q

MG

A

Myasthenia Gravis - autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups

88
Q

mean age of onset of MG

A

Mean age at onset in women is 28 years, men 42 years

Women are affected more than men (3:2)

89
Q

Overall goals for the patient with MG

A
  1. Have a return of normal muscle endurance
  2. Manage fatigue
  3. Avoid complications
  4. Maintain a quality of life appropriate to the disease course
90
Q

MG treatment

A

Drug therapy:
- Anticholinesterase agents (enhance transmission of Ach)
- Corticosteroids
- Immunosuppressive agents
Surgery (thymectomy) – presence of the thymus gland in patient with MG enhances the production of Ach antibodies

91
Q

MG exacerbation

A

myasthenia crisis

92
Q

myasthenia crisis

A

an acute exacerbation of muscle weakness triggered by respiratory infection, surgery, emotional distress, or pregnancy

93
Q

Prevention of myasthenia crisis

A

educate patient on signs and symptoms of respiratory infection

94
Q

HBV

A

a blood-borne pathogen that can cause either acute or chronic hepatitis

95
Q

HCV

A

RNA virus that is primarily transmitted percutaneously

96
Q

Overall goals for the patient with HBV or HCV:

A
  1. Have relief of discomfort
  2. Be able to resume normal activities
  3. Return to normal liver function without complications
97
Q

Nursing implementation of HBV

A

identify those at risk, screen for HBV, vaccinate those who have not been infected

98
Q

Nursing implementation HCV

A

no vaccine currently available. Therefore educate high-risk patients on using infection control precautions and modifying high-risk behavior

99
Q

signs of cancer - CAUTION

A

change in bowel/bladder, a sore that doesn’t heal, unusual bleeding or discharge, thickening of a lump, indigestion, obvious change in wart/mole, nagging cough

NURS level 3 (10 decks)

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