Exam 1 Study Guide: Q Flashcards
preventing harm and ensuring the patient’s well-being
non-malficence
self-determination or self-management
the right to make ones own decisions
autonomy
promotes positive actions to help others
beneficence
the nurse’s obligation to tell the truth to the best of their knowledge
veracity
the nurse will keep obligations or promises to patients and family
fidelity
equality and fairness, all patients should be treated equally and fairly
social justice
what is one sign of age related hearing loss?
answering questions incorrectly on a consistent basis
caused when sound waves are blocked to the inner ear, due to an obstruction of the external or middle ear, or disorders of these areas
can be d/t otitis media and impacted cerumen
conductive hearing loss
exposure to loud noice
sensorineural hearing loss
what is the snellen chart used for?
visual acuity
what is the ishihara chart used for?
assess color vision
what are measures to prevent hearing loss?
- wear earplugs or ear muffs when exposed to loud noise
i.e. shooting guns, concerts, heavy machinery, airport employees, etc.
what are techniques for communicating with the hearing impaired?
use a lower tone of enhance reception
loss of central vision
- affects the part of the eye responsible for central vision, fine detailed vision, and blindness.
macular degeneration
what are risk factors for macular degeneration?
high cholesterol
diabetes
hypertension
obesity
decreased zinc levels
smoking
age older than 60
female
Caucasian
family hx
s/s of cataracts
blurry vision
halo vision around light sources
fading or yellowing of colors
double vision in a single eye
risk factors of cataracts
diabetes
sun exposure
other chronic medical conditions at higher risk for cataracts
patients with autoimmune diseases have higher risk from chronic steroid use
what are important points about cataract surgery?
- decreased vision is an unexpected finding and could indicated infection
- slight eyelid swelling, mild eye itching, and scant drainage and normal
- sleep on the unoperated side/back to promote drainage of IOP
mydriatic drops will dilate and be prescribed for surgery prep.
wear a prescribed eye patch to reduce eye movement, decrease discomfort, and for eye protection
how should a patient be positioned post-op following eye surgery?
positioned 30 - 45 degrees post-op to reduce intraocular pressure
what are important points following middle ear surgery?
rapid bending from waist should be avoided for 3 weeks (no mopping, vacuuming, etc)
- patient will not be able to hear for several weeks after surgery
- dr will remove dressing at f/u appointment
- wait till POD1 to wash their hair
what is one way to prevent cataracts?
wearing sunglasses
what are precautions for a client with glaucoma?
- increased intraocular pressure, client should avoid/minimize activities that further increase IOP
i.e. heavy lifting, straining during a bowel movement, sneezing, coughing and bending over
increased IOP that causes damage to optic nerve - loss of vision and blindness in sever cases
glaucoma
treatment for glaucoma
use eye drops daily for life
- including miotics to constrict the pupils, carbonic anhydrase inhibitors to decrease aqueous humor production, and beta-blockers to decrease IOP
what are important points around glaucoma screening?
55+ recommended to have glaucoma screening every 1-2 years
tonometer - measures ocular pressure in clients with glaucoma
what are important points when administering eye drops?
- wash hands
- pull bottom eyelid down and instill the prescribed number of drops
what is an expected finding with Meniere’s disease?
bilateral or unilateral hearing loss
what are important points for a patient with vertigo?
change positions slowly with these patients - dangle legs
- may require nausea medication
- should evenly space out fluid intake throughout the day
- fall precautions
what are important points with ototoxic medications?
gentamycin:
monitor peak and trough levels because gentamycin may be ototoxic and cause tinnitus/hearing loss
ototoxic meds are commonly associated with inner ear disorders (tinnitus)
have patient’s with tinnitus keep diary of what they were doing when it occurred, including date/time/symptoms experienced
what does a sudden onset of floaters in the field of vision indicate?
retinal detachment
s/s of bacterial conjunctivitis
purulent eye drainage
- feeling of sand in the eye
s/s of viral conjunctivitis
pink and inflamed sclera and conjunctiva
- pink eye
- tearing, often bilateral
s/s of chlamydial conjunctivitis
photophobia
sticky eye, mucous discharge, tearing
what are important points about collaborating care?
the patient is the center of the team, and our goal is to facilitate healing
there are always other options to consider to reach that goal, and it is important to involve the patient and family in these options
what is the process for choosing a rehab hospital for the patients?
case management will provide options for the patient and they will choose the venue
what is the role of speech therapist?
assesses, diagnoses, and treats patients with disorders relating to speech, language, swallowing, voice, and cognitive - communication
common in stroke patients
develops specific exercises and recommends food consistencies for patients with dysphagia, dysarthria, and a tracheostomy to help prevent complications
what are the 6 cultural specifics that influence health?
communication
space
time orientation
social organization
environmental control
biological variations
cultural language
- language differences present one of the most difficult obstacles to providing individualized, patient-centered care
biological orientation
include ways in which people are different genetically and physiologically, including body variations and drug metabolism
create susceptibility to certain diseases and injuries and explain differences in response to treatment
cultural space
person’s personal space, or the boundaries that determine how close another person can be to another person
time orientation
two dimensions:
- related to clock time versus social time
- relates to whether the culture is predominantly concerned with the past, present, or future
important points about the right to informed consent?
- during pre-op teaching if the client has questions about the procedure, you need to contact the doctor who will be performing the procedure
0 do not let a patient sign a consent form if they have not spoken to the doctor or if they have questions for the doctor
HIPAA?
health insurance portability and accountability act
standards that protect the confidentiality, integrity, and availability of data as well as standards that define appropriate disclosures of identifiable health information and patient rights protection
classification system that considers the size of the tumor, burden of the disease, and extent of disease
staging
tumor, node, and metastasis x-unable to evaluate
0 - no evidence
1-4 severity
i.e. T1N3Mx
TNM staging
s/s of bladder cancer
hematuria
abdominal discomfort
distended abdomen
low back pain
ways to prevent skin cancer
SPF 30
dark/UV protected clothing
stay of of the sun between 1000 - 1600
at what ages should women get annual breast exams?
40+:
should have an annual clinical breast examination because of the increased risk after age 40
20 - 39yo:
should have clinical breast examinations every 3 years
important points following a skin biopsy
- erythema, edema, increased pain, or drainage develops, clean the site with hydrogen peroxide
- bandage should be changed daily
- showering is allowed the day after the biopsy
- small amount of red drainage is normal
- may take one or two weeks for the site to heal
who is at increased risk of obesity related chronic disease?
increased risk for type 2 DM, heart disease, and high blood pressure
BMI: 25 to 34.9
waist circumference in men >102cm (40 in)
waist circumference in women > 88cm (35 in)
what are signs of alcohol withdrawal syndrome?
tachycardia
irritability
tremors
how do you determine which patient to see second?
MAAUAR
M = mental status change
A = acute pain
A = acute impaired urinary elimination (< 30ml/hr or 6hrs since foley removal and anuria occurs)
U = untreated
A = abnormal labs
R = risks
what are examples of negligence and malpractice?
- failure to document
- failure to assess and monitor patient
- not following standards of care
- improper delegation
- failure to communicate critical labs
what are patients rights?
- refuse care or meds
- right to medical records
- continuity of care
- confidentiality
- privacy
- explanation of their bill
5 primary documentation guidelines
factual
accurate
current
organized
complete
5 primary documentation guidelines
factual
accurate
current
organized
complete
tuning fork on the head tests for what?
bone conduction
hardening of the inner ear bones
can lead to conductive hearing loss
otosclerosis
what condition causes tunnel vision?
Glaucoma
important points for post-op glaucoma surgery?
use stool softeners to prevent straining and increased IOP
keep head of bed elevated 35045 degrees to reduce IOP
who evaluates a patient who had a stroke, difficulty swallowing, and failed swallow study
speech therapist
determine diet order, liquids
can HIPAA protect patient and prevent provider from reporting STD test results to the state?
No
in TNM staging, how do we know if there is lymph node involvement?
indicated by the N-N3-3 nodes involved
s/s of bladder cancer
lower abdominal pain
hematuria
is a patient who takes opioids daily for chronic pain/long term that experiences tremors when a dosed is missed addiction?
No
physical dependence
strong genetic component w/addiction for alcohol, nicotine, hard drugs
what is a long-term effect of macular degeneration and untreated glaucoma?
blindness
what condition is a 65 yo women with high cholesterol at risk for?
macular degeneration
how do we administer ear drops to an adult?
pull pinna up and back
patient with stage four T3, N3, M1 - are there lymph nodes involved? has it metastasized?
yes - 3 lymph nodes
yes - metastasized
macular degeneration:
modifiable risk factors
high cholesterol
diabetes
obesity
decreased zinc levels
smoking
macular degeneration:
non-modifiable risk factors
age older than 60
female gender
caucasian race
family hx
primary prevention initiatives include:
risk factor modification (avoiding carcinogens)
immunization
chemoprevention
continued use leads to a breakdown in patters of daily living
addiction
increasing frequency and amount of use
drug dependency
