Contemp quiz 2 Flashcards
● Autonomy:
independence, making own decisions, freedom of choice, self-rule, ability to act on own decisions
o Short-term and long-term autonomy
● Beneficence:
doing well for someone; putting their interest ahead of your own interests.
● Justice:
fair treatment, distribution of benefits and rewards
● Respect for persons:
dignity; effective communication
● Paternalism:
imposing your beliefs on someone else; using authority and power; overriding someone’s autonomy
● Power dynamic:
patients are vulnerable and HCP may impose their beliefs
● Fiduciary relationship:
advocating for patient; you’re the expert and because of that, you have a responsibility to act on the patient’s behalf and their best interest
o Nurses have a fiduciary relationship with patients by providing the best outcomes, making sure pts are well taken care of
● Personal payments appear to be MORE OR LESS effective than information about changing behavior.
MORE EFFECTIVE
What are some important factors that influence quality of care? (5 factors)
- financial
- relationsips
- race/ethnicity
- attitudinal
- provider, healthcare, and practice driven factors
What are examples of provider/healthcare/practice driven factors influencing quality of care?
o Lack of experience in HCP, not doing screenings
o Attitudes that exist in the public domain effect professional beliefs.
▪ Stigmatizing : “Substance abuse is a moral weakness.”
▪ Labeling
▪ Stereotyping
▪ Marginalization – social exclusion, social disadvantage and relegation to the fringe of society.
▪ Contempt/disdain
▪ Acceptance
▪ Empathy
▪ The language we use
Examples of potential negative provider behaviors:
- The language we use
- Spending less time with negatively viewed patients
- Failing to advocate for patients
- Hurrying patients
- Being hostile or angry toward the patient
- Delaying or withholding care
- Enforcing rules indiscriminately
• Pseudoaddiction:
A drug-seeking behaviour that simulates true addiction, which occurs in patients with pain who are receiving inadequate pain medication
Examples of Organizational Level factors that can act as barriers in SUD treatment
● Inappropriate Tx match to the specific population.
● Organizational culture
● Concerns of negative reactions from other nurses and administration
● Turning away individuals who need help.
Moral dissonance
● Feelings of guilt and shame about not acting ethically
- When people are stigmatizing and you feel differently, you feel dissatisfaction
- The mental stress or discomfort experienced by an individual who holds 2 or more contradictory beliefs, ideas, or values at the same time; performs an action that is contradictory to 1 or more beliefs, ideas, or values; or is confronted by new info that conflicts w existing beliefs, ideas, or values
Possible manifestations of ethical erosion after caring over a long period of time.
● Justification (You justify why you treat patients in the way that you do after a while of working in an environment that stigmatizes pts with substance abuse)
● Rationalization
Etiology of SUDs
● Multi-determined
o Neurophysiology changes when you use substances
o Access to drugs influences substance use
● Separate entities or co-occurring disorders
● Severe SUDs are chronic, recurring disorders
● Severe SUDs are characterized as disease
Tolerance:
need for increased amounts or markedly diminished effect with same amount of substance
Withdrawal
development of a substance specific withdrawal signs and symptoms, or a closely related substance is taken to relieve or avoid withdrawal symptoms.
Daily Marijuana use INCREASED OR DECREASED in 8th, 10th, 12th graders from 2009-2010?
increased
12th graders: at highest point since early 1980s at 6.1%. “Perceived risk” of regular marijuana use declined in 10th & 12th graders
After MJ, what drugs account for most of top drugs abused by 12th graders in past year?
prescription & OTC meds
-In 12th graders, past year nonmedical use of Vicodin decreased from 9.7% to 8%. But past year non-medical use of Oxycontin remains unchanged across the three grades; has increased in 10th graders over the past 5 years. Past-year nonmedical use of Adderal & OTC cough and cold medicines among 12th graders is high at 6.5% and 6.6%, respectively.
● Alcohol use has continued to INCLINE OR DECLINE among high school seniors with past-month use
decline
-falling from 43.5% to 41.2% and alcohol binge drinking (defined as 5 or more drinks in a row in the past 2 weeks) declining from 25.2% to 23.2%. Declines were also observed for all measures among 12th graders reporting the use of flavored alcoholic beverages. Past-year use fell from 53.4% to 47.9%.
tobacco product use is highest among which ethnicity?
native american/alaskan (40.1%
what age group rates highest in tobacco product use?
18-25 year olds
Alcohol use disorder is higher among what age and gender?
18-29 year old men
Alcohol use disorder is higher among what ethnic groups?
whites and native americans
NIAAA Recommended Level to Reduce Likelihood of Negative Health Outcomes in PREGNANT WOMEN
no known level of safe consumption
NIAAA Recommended Level to Reduce Likelihood of Negative Health Outcomes in PPL WITH CO-MORBID HEALTH CONDITIONS
minimal or no consumption
NIAAA Recommended Level to Reduce Likelihood of Negative Health Outcomes in MEN AND WOMEN
● Women of all ages: 1 drink/day or 8 drinks/wk: no more than 3 drinks on one occasion
● Men below 65: 14 drinks/wk. No more than 4 drinks/occasion
what is the “standard” drink size for wine?
o 4-5 oz. wine
what is the “standard” drink size for beer?
o 12 oz. Beer
what is the “standard” drink size for spirits?
o 1 ½ oz. of spirits
NIAAA stands for
NIAAA= National Institute on Alcohol Abuse and Alcoholism
What does SBIRT stand fort?
Screening, Brief Intervention, and Referral to Treatment (SBIRT) i
What is SBIRT
-An evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.
• Screening (S): ability to use and interpret brief interviewing instruments and recognize common medical warning signs of SUDs.
• Brief Intervention (BI): evidence-based approach which takes into account that a significant # of pts w SUDs will reduce their substance use after receiving simple, tailored advice to quit or cut down.
• Referral for Tx (RT): requires that HCP know enough about local Tx resources that they can effectively and appropriately refer.
● Tool is most effective w/ persons drinking harmfully
4 important health considerations when thinking about alcohol use disorder
● Women more vulnerable to alcohol related health problems even when alcohol is consumed at lower levels (pregnancy, breast cancer).
● Long-term heavy consumption results in cardiovascular changes, GI illness, head and neck cancers.
● High correlation btw nicotine dependence and alcohol dependence.
● Heavy drinking exacerbates and worsens psychiatric symptoms.
What disease contributes most to the global burden of disease?
● Illicit and legal (tobacco and alcohol) drug use contribute most to the global burden of disease (medical co-morbidities, frequent hospitalization, need for long term care, accidents and fatalities, lost productivity)
5 steps for treating Severe Substance Use Disorder
● Assess & Dx level of severity of substance use disorder
● Initiate interpersonal and/or pharmaco-therapy (medication assisted treatment)
● Recommend self-help therapies and 12 step program involvement
● Monitor adherence and treatment response
● Evaluate response to treatment and modify as necessary
what is the CRAFFT screening tool?
Screens adolescents for substance abuse.
-6 questions for those under 21 made by the American Academy of Pediatrics
what screening tool can we use to test for substance abuse in older adults?
● SMAST- G (older adults):10 Q’s. Each positive answer + 1 pt. Sensitivity: 93.9 %; Specificity: 78.1%
4 simple steps for screening for alcohol/drug abuse?
- ›Screen using a population specific/ standard tool
- ›Brief Intervention ( BI) or Brief Negotiated Intervention ( BNI)
● ›Raise subject: ask permission; establish rapport; assess comfort regarding intake and possible consequences
● ›Provide feedback: Review ATOD; connect use and negative consequences; make connection between use and medical visit; discuss issues related to withdrawal and dependence (as necessary) - Enhance Motivation: explore feedback, assess readiness to change, boost motivation
- Negotiate and Advise: review options, negotiate goal
what’s the 2nd most commonly used drug among adolescents aged 12-17 years?
solvents (Volatile solvents like aerosols, gases, nitrites, vcr & computer cleansers, butane lighters & refills)
Scoring Factors for CRAFFT tool
Severe substance use disorder includes 3 or more of the following:
● Tolerance
● Withdrawal
● Substance taken in larger amount or over longer period of time than planned
● Unsuccessful efforts to cut down or quit
● Great deal of time spent to obtain substance or recover from effect
● Important activities given up because of substance
● Continued use despite harmful consequences
the recent trend of increasing opioid abuse is highest among which age group?
young adults, aged 18-25
What defines safe alcohol use in men?
● Men: no more than 4 drinks on any one occasion and less than 14 drinks per week define safe drinking.
What defines safe alcohol use in women?
● Women: no more than 3 drinks on any one occasion or less than 7 drinks per week define safe drinking
Are individuals who are able to maintain employment more or less likely to recognize their substance use problem?
less likely
What factors might increase likelihood of SUD relapse in a HCP? (3 risk factors)
o Presence of coexisting psychiatric illness
o A family history of SUDs
o Abuse of opioids
What are barriers for physicians, nurses, dentists, and other HCP to providing effective substance abuse disorder identification and referral for treatment?
- time limitations
- attitudes
- SUD Tx is often limited or unavailable
definition and examples of social determinants of health
“the conditions in which persons are born, grow, live, work, and age, including the health-care system” Examples: Gender Race SES Knowledge Location
What is a DALY
The disability-adjusted life year: a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Person’s life expectancy might be shorter due to their disease/disability (e.g. men in Russia have a life expectancy of 57 due to alcohol and spread of tuberculosis).
what are the implications of DALY scores
if you have ppl who are unable to contribute to society d/t disease burden, then they cant contribute economically. They run risk of becoming economic burdens to their families, becoming homeless, or becoming very expensive to the society they are living in d/t their health care cost
If DALYs are HIGH= there are a lot of health care related issues that are being poorly managed
what is the global burden of disease:
how diseases burden different countries/societies. Combo of non-communicable disease, infectious diseases, vector-borne diseases, and accidents/trauma and how these influence society
As countries become richer, what is the trend we tend to see with their disease patterns?
as countries become more wealthy, they have LESS infectious diseases and MORE non-communicable diseases
Why is HIV still one of the most challenging for healthcare workers and researchers?
because of its physiologic complexity and link to human behavior.
what are the 3 types of migrants?
o Legal: Work visa; Asylum seeker; Green card (or equivalent) lottery winners
o Undocumented: ppl crossing borders and seeking work; pay into tax system
o Refugee: refugee resettlement program (highly educated individual may only be able to have a low skill set job bc they are unable to retrieve documents of their education).
what is a health disparity?
a particular type of difference in health; a difference in which disadvantaged social groups—i.e. poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination—systematically experience worse health or greater health risks than more advantaged social groups
What is health Equity:
everyone has the opportunity to “attain their full health potential” and no one is “disadvantaged from achieving this potential because of their social position or other socially determined circumstance”
What is explicit bias:
- Self-awareness
- Intentional
- Belief that behavior is justified
What is implicit bias:
- Unconscious
- Activated by situational and social cues
- Influenced by perception, behavior, and memory
What is the lifecourse perspective?
● Idea that childhood experiences affect you down the line for the rest of their lives
● Adverse childhood experiences affect health into 40-50s
● 1st 3 yrs of life – malnutrition poor educational outcomes
in what area do we see the highest rates of health disparities?
cancer
- blacks have highest mortality rate for ALL CANCERS
- black women more likely to die from breast cancer despite lower risk of developing
- black men at higher rates of lung and prostate cancer
- stomach cancer 70-240% higher in blacks vs whites
LGBT have among the highest rates of alcohol, tobacco and drug use in the US. WHY IS THIS?
§ Combination of: • Personal risk behaviors • Social and economic realities • Stigma • Provider factors
what is the SAD COST model?
Mnemonic to help address issues that are most highly correlated with LGBT health and health disparities (not exclusive)
what does SAD COST stand for?
§ S: STIs and risky sexual behaviors
§ A: attitudes, including those of HCPs
§ D: depression, anxiety and suicidality
§ C: cancer and CVD
§ O: overweight, obesity, eating disorders
§ S: substance abuse
§ T: trauma and violence
What is meant by a “terminal drop” that is a final preparation for death?
o Unconscious changes just before death
▪ Drop in memory and learning
▪ Individuals become less emotional, introspective, and aggressive; more conventional, dependent, and warm
What are Elisabeth Kubler-Ross’s stages of dying? (5 stages)
- denial
- anger
- bargaining
- depression
- acceptance
▪ Reactive depression -
compounded by loss – function, finances, employment
▪ Preparatory depression –
impending loss, final separation, reassurance is not useful
what is palliative care?
• Care that that aims to relieve suffering and improve quality of life simultaneously with all other appropriate treatment for patients with advanced illness, and their families
what is clinical death?
- -the few minutes after heart stops pumping, breathing stops, and there is no evidence of brain activity, but resuscitation is still possible
i. Transplant needs to be done at this stage while organs are still alive
ii. Death as judged by med observation of cessation of vital functions.
iii. 3 major things: Can’t hear heart beat, Absence of RR, No pulse detectable
iv. Start CPR, AED start a lifesaving measure
what is biologic death?
o Death of major organs, can no longer be used for transplant
what is brain death?
-person no longer has reflexes or any response to vigorous external stimuli; may still be able to breathe and survive for some time.
Brain death is death
Cause: trauma, intercranial bleeds, strokes, ICP, tumors
Will be on ventilator, have heart beat & rr, physical body is alive but is legally dead (no chance of brain coming back alive)
Why are still ventilating? – Organ donations (#1 face #2 hands)
social death
-person is treated like a corpse by others
● Biologic Futility:
Treatment cannot restore, maintain, or enhance biologic life; no clinically relevant physiological effect
● Cognitive Futility:
Treatment cannot restore, maintain, or enhance cognitive life; no purposeful interaction with environment
● Desired Life Futility:
Treatment will not promote life desired by patient
● Physiologic futility:
Treatment fails to render a predictable physiologic effect
i.e. whatever we’re doing is failing – i.e. can’t bring kidney back to full function
● Quantitative futility:
In the last 100 cases, a medical treatment has been useless
● Qualitative futility:
Failure to end dependence on intensive medical care (do we want to continue painful therapies?)
● Imminent Demise Futility:
Patient will die before discharge
What is the “cocktail” for the assisted dying prescription? Rules on how to administer it?
● Secobarbitol 9 Gm dose in capsules
● Pentobarbitol 10 Gm dose in liquid form
● Take on an empty stomach
● Mix with juice or other sweet beverage
● Antiemetic 1 hour before dosing
● Note: as a prescribed anxiolytic or a sedative drug, the dose is 100mg at hs
what does the spiritual assessment form include?
- Life Review and assessment of spiritual needs/accomplishments
- Hopes, values and fears
- Meaning, purpose, beliefs about an afterlife, spiritual or religious practices, cultural norms, beliefs that influence understanding of illness, coping, guilt, forgiveness, and life completion tasks (life closure)
- Incorporates beliefs/feelings about cure, miracles, conflicts in care created by spiritual beliefs/religion, family desires/pressures
