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NURS level 3 > chronic illness Final Exam > Flashcards

chronic illness Final Exam Flashcards

1
Q

Evidence based care improves

A

quality, safety, patient outcomes, nurse satisfaction, and reduced cost

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2
Q

Steps to EBP

A
  1. ask a clinical question in PICOT format
  2. search for the most relevant and best evidence
  3. Critically appraise the evidence you gather
  4. Integrate all evidence with your clinical expertise and patient preferences and values
  5. Evaluate the outcomes of practice decisions or changes using evidence
  6. Share the outcomes of EBP changes with others
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3
Q

PICOT

A

patient population of interest, intervention of interest, comparison of interest, outcome, time

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4
Q

Expert Opinion

A

evidence from the opinion of authorities and/or reports of expert committees

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5
Q

Case-Controlled Studies/Case Series

A

identifies patients who have the outcome of interest (cases) and control patients, and looks for exposure of interest

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6
Q

Cohort Study

A

identifies 2 groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and follows these cohorts forward for the outcome of interest

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7
Q

RCTs

A

randomized group of patients in an experimental group and a control group. These groups are followed up for the variables/outcomes of interest.

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8
Q

Critically Appraised Articles

A

authors evaluate and synopsize individual research studies

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9
Q

Critically Appraised Topic

A

authors evaluate and synthesize multiple research studies – check and balances system – a group of individuals look over the article and decide if it’s a good study

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10
Q

Systematic Reviews

A

authors have systematically searched for, appraised, and summarized all of the literature for a specific topic

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11
Q

Meta-Analysis

A

a systematic review that uses quantitative methods to summarize the results

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12
Q

in step three: Critically appraise the evidence you gather

you must determine

A

value
feasibility
usefulness of the evidence

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13
Q

Validity

A

the degree to which methods are really measuring the concepts they are supposed to measure

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14
Q

Reliability

A

the accuracy and consistency of information obtained in a study

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15
Q

Bias

A

an influence that results in an error in an inference or estimate

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16
Q

bias can effect

A

the quality of evidence and the validity of the study

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17
Q

Quantitative Nursing Research

A

The study of nursing phenomena that offers PRECISE measurement and quantification
Focuses on numerical data, statistical analysis, and controls to eliminate bias in findings

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18
Q

Qualitative Nursing Research

A

The study of phenomena that are difficult to quantify or categorize such as patients’ perceptions of illness or quality of life
Describes information obtained in a nonnumeric form

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19
Q

examples of vulnerable populations

A 
Older adults
Homeless
Immigrant populations
Children
Severe mental illness
Terminally ill or physically disabled
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20
Q

Concepts to Consider when Conducting Research in Special Populations…

A

powerlessness, vulnerability, self-concept, hardiness, resilience, wellness, quality of life

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21
Q

Informed consent means that participants:

A

have adequate information about the research
can comprehend that information
have free choice in deciding whether to participate in or withdraw from the study

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22
Q

Informed consent protects the rights of the research participant by meeting the rights to:

A

Self-determination
Privacy
Full disclosure

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23
Q

Beneficence encompasses three duties

A

The duty to protect from (a) harm and (b) exploitation, and (c) duty to balance risks and benefits

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24
Q

Researchers must protect study participants from all types of harm including

A

Physical, Psychological, Delayed effects of research that may be harmful

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25
Q

In general, research with vulnerable groups should be undertaken only when

A
  1. The risk/benefit ratio is low OR

2. There is no alternative

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26
Q

An explicit health policy can achieve several things:

A
  1. Defines a vision for the future
  2. Outlines priorities and the expected roles of different groups
  3. Builds consensus
  4. Informs people
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27
Q

six steps of policy analysis

A
  1. define and analyze problem
  2. policy alternatives
  3. evaluate criteria
  4. assessment of alternatives
  5. stakeholders
  6. recommendations
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28
Q

policy problem

A

existence of an unsatisfactory set of conditions for which relief is sought

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29
Q

policy alternatives

A

no change, incremental change, comprehensive change

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30
Q

incremental change

A

May be more feasible, but may not fully resolve the problem

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31
Q

Comprehensive/Major change

A

What alternative would provide EVERYTHING needed to resolve the problem?

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32
Q

evaluation criteria for policy

A

effectiveness, efficiency, equity, liberty, feasibility, acceptability

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33
Q

access to health services requires

A
  1. Gaining entry into the health care system (usually through insurance coverage)
  2. Accessing a location where needed health care services are provided (geographic availability)
  3. Finding a health care provider whom the patient trusts and can communicate with
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34
Q

Access to health care impacts one’s

A

overall physical, social, and mental health status and quality of life

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35
Q

healthy people 2020 Focuses on 3 components of access to care

A
  1. Insurance coverage
  2. Health services
  3. Timeliness of care
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36
Q

5 ways to improve access to health care are:

A
  1. Retain Medicaid expansion and implement expansion in more states
  2. Retain ACA reforms and stabilize individual insurance marketplaces
  3. Address clinical workforce shortages
  4. Telehealth and remote patient monitoring
  5. Increase efficiency of existing workforce
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37
Q

health promotion

A

is a basic nursing function. we do this through:

  1. individual counseling
  2. public health education programs
  3. provision of health service
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38
Q

primary prevention

A

intervening before health effects occur
Vaccinations
Altering risky behaviors (poor eating habits, tobacco use)

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39
Q

secondary prevention

A

screening to identify disease in the earliest stages, before the onset of signs and symptoms
Mammography
Regular blood pressure testing

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40
Q

tertiary prevention

A

managing disease post diagnosis to slow or stop disease progression
Rehabilitation
Chemotherapy

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41
Q

disparity

A

differences in the presence of disease, health outcomes, or access to health care between population groups

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42
Q

inequity

A

unnecessary and avoidable differences in health that are considered unfair and unjust

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43
Q

5 Overarching recommendations for health promotion and disease prevention in vulnerable populations:

A
  1. Promote health equity across racial, ethnic, and socioeconomic lines
    Embed health equity into practices and policies
  2. Provide federal resources to support state, local community-based prevention strategies
    Reimburse community-based prevention
  3. Tackle inequities of money, resources, etc.
  4. Improve access to quality education
  5. Invest in early childhood
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44
Q

Dr. Samuel Hahnemann came up with

A

Like cures Like” aka “The Principle of Similars”

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45
Q

examples of CAM

A 
Acupuncture
Aromatherapy
Herbalism
Homeopathy
Hypnosis
Massage
Meditation
Reflexology
Reiki
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46
Q

Categories of CAM Therapies

A

Natural Products:
Herbs, vitamins, minerals, probiotics
Mind-Body Practice:
Acupuncture, massage therapy, meditation, movement therapies, spinal manipulation, yoga
Other:
Ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy

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47
Q

conventional medicine

A

Treats human body in parts, not a whole
“Rescue Medicine”
Disease-based model

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48
Q

Complementary & Alternative Medicine

A

Approach to treatment is focused primarily on proactive measures
Treats the condition, not the symptoms

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49
Q

Integrative Medicine

A

The fusion of conventional medical practice and practices of complementary and alternative medicine.

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50
Q

CAM Principles of Care

A

Health & healing are related to a harmony of mind, body, & spirit
The body has the ability to heal itself
Basic positive health practices build the foundation of healing
Approaches to healing are individualized
Individuals are responsible for their own healing

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51
Q

Homeopathic Medicine: Patient Teaching

A

It is important to educate our patient’s on homeopathic medications that have been shown to interact with other drugs

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52
Q

CAM Therapies for emphysema

A

Nebulized glutathione (mother of all antioxidants)

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53
Q

CAM Therapies for cardiovascular disease

A

Co-enzyme Q10 – as we age Q10 decreases.

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54
Q

CAM Therapies for peripheral neuropathy

A

B vitamins (B12)
ALA (Alpha-lipoic acid)
Acupuncture

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55
Q

CAM Therapies for Parkinson’s disease

A 
Amino acids (Tyrosine, Phenylalanine, Tryptophan)
B vitamins (B6 & Thiamine)
Glutathione
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56
Q

Black Cohosh (used for menopause to treat hot flashes) can have interactions with

A

Increased risk of liver toxicity if taken with atorvastatin, acetaminophen, or alcohol

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57
Q

Coenzyme Q10 should not be used with

A

anticoagulant drugs, decreases effectiveness of the anticoagulant and increases the risk of clots

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58
Q

Echinacea (stimulates immune system) interacts with

A

Slows caffeine breakdown leading to jitteriness, HA, or insomnia

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59
Q

Evening Primrose Oil (fatty acids used by the body for growth) should not be taken with

A

Increases risk of seizures in patient’s taking anti-convulsants

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60
Q

St. John’s Wort (used for symptoms of depression) Contraindicated when

A

Contraindicated when used concomitantly with SSRIs, MAOIs, tricyclic antidepressants, warfarin, and birth control

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61
Q

hospice care

A

Used for terminally ill patients when treatment is no longer curative during the last 6 months of life, assuming the disease takes its natural course

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62
Q

palliative care

A

Addresses the patient’s physical, emotional, and spiritual needs (just like hospice), however palliative care is also focused on relieving symptoms associated with the patient’s condition while receiving active treatment

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63
Q

Hospice and insurance

A

paid in full by the Medicare Hospice Benefit and by Medicaid Hospice Benefit. Most insurances and VA also cover in full or with minimal co-pays

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64
Q

palliative care and insurance

A

paid by Medicare, Medicaid, and most private insurances IF the patient meets criteria

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65
Q

physical changes during end of life

A 
Incontinence
Loss of appetite
Semi consciousness
Dysphagia 
Changes in respiratory pattern
	-Cheyne Stoke
Mottled skin
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66
Q

nursing management during end of life

A 
Comfort
	-Pain management
Oral care – sponge swabs
	-Keeps oral mucosa moist
Positioning
	-Raising bed to semi fowlers
Terminal respiratory secretions (“Death Rattle”)
	-Scopalamine
Warm blankets
Family support
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67
Q

types of forms used in end of life

A

Advanced Directives:
Durable Power of Attorney for Healthcare
Durable Power of Attorney for Finances
Living Will

  1. POLST
  2. Will
  3. Living Trust
68
Q

Advanced Directives – Durable Power of Attorney for Healthcare

A

legal document that authorizes someone you trust to make medical decisions on your behalf

69
Q

Advanced Directives – Durable Power of Attorney for Finances

A

Gives an individual the authority to perform certain specified acts on behalf of the principal even if that person becomes disabled or legally incapacitated

70
Q

Advanced Directives – Living Will

A

A written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are unable to express their consent or wishes

71
Q

A Living Will Specifies

A 
DNR
DNI 
IV Fluids
NG Tube/PEG Tube
Pain Medications
72
Q

POLST

A

Physician Order for Life-Sustaining Treatment

73
Q

3 key features of a POLST

A
  1. Completed WITH your healthcare professional to direct the kinds of treatment you want in a medical crisis
  2. Becomes a medical order after signed by you and your PCP
  3. POLST travels with the patient
74
Q

Medicare will pay for ____________ to discuss a POLST

A

a 30 minute appointment with PCP

75
Q

Difference between a POLST and living will

A

911 obligated to resuscitate you if you are not in the hospital UNLESS they receive definitive information on the contrary
POLST = an order for a MD that applies even out of the hospital

76
Q

Living Trust

A

A living trust provides lifetime and after-death property management

77
Q

nursing management responsibilities

A 
Staffing
Employee satisfaction
Safety and quality
Customer satisfaction
Budgeting
78
Q

car coordination includes

A

patient, provider, and care team

79
Q

care coordination

A

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

80
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.
81
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
82
Q

what is chronic illness defined as

A

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

83
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
84
Q

causes of chronic disease

A

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

85
Q

1 complication of chronic disease

A

depression

86
Q

other complications of chronic disease

A

spiritual distress, fear, anxiety, and powerlessness

87
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

88
Q

management of Patient with COPD

A

maintenance medications are key + sick day plan

89
Q

management of patient with CHF

A

daily monitoring of weight and sodium intake + medication compliance

90
Q

8 phases of chronic illness

A
  1. onset
  2. stable
  3. acute
  4. comeback
  5. crisis
  6. unstable
  7. downward
  8. dying
91
Q

phase 1 onset of chronic illness

A

Signs and symptoms are present

Disease diagnosed

92
Q

phase 2 onset of chronic illness

A

Illness course and symptoms controlled by treatment regimen

Person maintains everyday activities

93
Q

phase 3 onset of chronic illness

A

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

94
Q

phase 4 onset of chronic illness

A

Gradual return to an acceptable way of life

95
Q

phase 5 onset of chronic illness

A

Life-threatening situation occurs

Emergency services are necessary

96
Q

phase 6 onset of chronic illness

A

Unable to keep symptoms under control

Life becomes disrupted while patient works to regain stability

97
Q

phase 7 onset of chronic illness

A

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

98
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

99
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!
100
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

101
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

102
Q

Delivery System Design

A

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

103
Q

decision Support

A

Promote care consistent with scientific data and patient preferences

104
Q

Clinical Information Systems

A

Organize data to facilitate efficient and effective care

105
Q

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

A

5 stages of grief

106
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
107
Q

transition between stages is an

A

ebb and flow, NOT a progression

108
Q

life alterations during a chronic disease

A

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

109
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
110
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

111
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
112
Q

self concept

A

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

113
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

114
Q

what is common in impact on families

A

Role reversal is common

115
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

116
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

117
Q

Work place issues vary greatly depending

A

on the level of disability and the job being performed

118
Q

Having a chronic illness increases the likelihood of using

A

sick leave/time off

119
Q

1 chronic disease in the US

A

cardiovascular disease (CVD)

120
Q

risk factors of CVD

A

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

121
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
122
Q

DASH diet

A

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

123
Q

Pharmacologic treatment goal

A

SBP < 130mmHg

124
Q

Strategies for Management of CAD

A

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

125
Q

Strategies for Management of MI/ACS

A

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

126
Q

CVD: Prevention of Complications

A

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

127
Q

Typical factors involved in worsening HF

A

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

128
Q

Early symptoms of HF exacerbations: (Think, FACES)

A 
F= Fatigue
A = Activity limitation 
C = Chest congestion/cough
E = edema
S = shortness of breath
129
Q

COPD: Strategies for Management

A

Inhalers

130
Q

COPD: Prevention of Complications

A

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

131
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

132
Q

COPD Exacerbation Treatment

A

“Sick Day Plan”

Antibiotic + Oral corticosteroid

133
Q

CKD: Strategies for Management

A

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

134
Q

CKD: Prevention of Complications

A

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

135
Q

DM: Strategies for Management

A 
Monitoring blood glucose
Oral medications
nutritional therapy
exercise
insulin
136
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
137
Q

DM: Prevention of Other Complications

A

Educate patient on signs and symptoms and treatment of hypoglycemia

138
Q

signs and symptoms and treatment of hypoglycemia

A

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

139
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
140
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

141
Q

HIV/AIDS – Strategies for Management and Prevention of Complications

A

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

142
Q

1 cancer in men

A

prostate cancer

143
Q

1 cancer in women

A

breast cancer

144
Q

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

A

By eliminating risk factors

145
Q

Colonoscopy screening guidelines (CDC, 2019)

A

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

146
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

147
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

148
Q

primary cause of death in the patient with cancer

A

infection so Educate pt on signs and symptoms of infection

149
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
150
Q

medication for RA

A

DMARDs

NSAIDs

151
Q

RA – Nursing Management and Prevention of Complications

A 
ambulatory care - alternate rest and activity
joint protection
heat and cold therapy
exercise
psychological support
152
Q

MS support

A

Onset usually between 20 and 50 years of age

Women are affected 2-3x more than men

153
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)
154
Q

Medications for MS

A

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

155
Q

exercise for MS

A

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

156
Q

MG

A

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

157
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)

158
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
159
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

160
Q

MG exacerbation

A

myasthenia crisis

161
Q

myasthenia crisis

A

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

162
Q

Prevention of myasthenia crisis

A

educate patient on signs and symptoms of respiratory infection

163
Q

HBV

A

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

164
Q

HCV

A

RNA virus that is primarily transmitted percutaneously

165
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
166
Q

Nursing implementation of HBV

A

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

167
Q

Nursing implementation HCV

A

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

NURS level 3 (10 decks)

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