Exam 4: Nutrition, Legal and Ethics, Spirituality, Elimination and Enema, Cultural Diveristy, CAM Flashcards
What factors affect bowel elimination?
age, diet, fluid intake, physical activity, psychosocial factors, personal habits, positioning, pain, pregnancy, meds
what is incontinence
inability to control defecation or urination
what are hemorrhoids
engorged, dilated blood vessels in rectal wall
what are causes of constipation? what are some interventions?
--Frequent use of laxatives Advanced age Inadequate fluid intake Inadequate fiber intake Immobilization due to injury Sedentary lifestyle Pregnancy Medication effects --Interventions: Increase fiber and water Give bulk forming products Enemas Encourage reg exercise
what are some causes of diarrhea? what are some interventions?
--Causes: Viral gastroenteritis Bacterial gastroenteritis Antibiotics Inflammatory bowel disease IBS
–Interventions:
Determine and treat cause
Admin meds to slow peristalsis
Eat yogurt once diarrhea stops
what are the different kinds of enemas? what are the details about them?
Enema types: (tap/saline; castile soap; fleet; oil)
–Tap water (hypotonic)/saline
500-1000 mL
Distends intestine, increases peristalsis, soften stool
15 min to take effect
Can lead to fluid and electrolyte imbalance, water intox, DO NOT USE IN KIDS
–Castile Soap
500-1000 mL (concentrate at 3-5 mL/1000 mL)
Distends intestine, irritates intestinal to stimulate peristalsis mucosa, soften stool
10-15 min to take effect
Must only use castile soap, others will cause rectal mucosa irritation/damage
–Fleet Enema–Hypertonic
70-130 mL
Draws fluids out of interstitial space into colon leading to distension, stimulates peristalsis
5-10 min to take effect
Avoid in dehydrated client, or where sodium retention could be a concern, can be irritating to rectum also
–Oil (mineral, olive, cottonseed)
150-200 mL
Lubricates stool and intestinal mucosa, used as retention enema
30 min to take effect (patient may need to hold solution for 30-60 min)
Adverse effects: rectal bleeding (long term)
what do you need to make sure you have before doing an enema?
physicians order
what are some complications caused by constipation? Diarrhea?
Constipation: Fecal impaction
Hemorrhoids and rectal fissures
bradycardia, hypotension, syncope
Diarrhea: Dehydration
Fluid and electrolyte disturbances
what to look for in urine and feces when observing?
color, consistency, odor, volume/amount, mucous, blood, sediment
what factors affect urinary elimination?
age, (prostate enlarges in older age, can obstruct bladder and UTIs), pregnancy, diet, immobility, psychosocial factors, pain, surgical procedures, medications
what are different ways for healthy urinary elimination?
urinal, toilet, bedpan, commode, fracture pan (supine only)
Risk factors of catheter-associated urinary tract infection? Manifestations?
Use of indwelling catheters Increased dwell time of catheter Opening the closed urinary drainage system Routine changes Irrigation of catheter
manifestations:
Urinary frequency, nocturia, flan pain, hematuria, cloudy, foul smelling urine, fever
Older adults: confusion, recent falls, new onset incontinence, anorexia, recent tachycardia, hypotension
what are the different types of urinary incontinence? what are the risk factors?
Stress Urge Overflow Reflex Functional Transient
risk factors: female, preg history, obesity, neuro disorders, decreased estrogen levels, confusion, immobility, dementia
what are the macro (essential) and micro (non-essential) nutrients? What are the purposes of each group?
–Macronutrients–energy
Carbohydrates
Proteins
Lipids
–Micronutrients–important for processes and growth
Vitamins
Minerals
(Also water)
what are carbs, proteins, and lipids for?
--Carbs Used for energy Each gram produces 4 kcal of energy Easiest to store Intake correlated to income (intake increases, income decreases)
--Proteins Tissue building Utilized for growth Protein synthesis Using protein for energy is more expensive financially and physiologically
--Lipids Storage & energy Most concentrated form of energy Insoluble in water/blood Saturated & unsaturated fatty acids--manufactured usually Trans fat Raises Cholesterol Each gram produces 9 kcalories energy Necessary for metabolic processes
what do vitamins and minerals do?
--Vitamins Catalyze metabolic processes Are organic compounds needed by the body in small amounts Do not provide energy Water soluble or fat soluble
–Minerals
Are inorganic elements found in all body fluids and tissues
Provide structure within body
Regulate body processes
Macro-minerals
Micro-minerals–trace elements (iron, zinc etc)
what is water and how does it change when aging?
- -The major body constituent present in every body cell
- -Accounts for between 50 – 60 % of adult’s total weight
- -Babies have mostly water
- -Total body water decreases with age, intracellular water increases
- -Provides the fluid medium for all chemical reactions of the body
- -The body’s most basic nutrient
- -Water is a solute
- -No calories
- -Foods include water, so monitor I&O
what factors affect nutrition?
Physical – state of health Psychological – environment Culture/ethnicity/religion One’s education (or lack of) Socioeconomic status and roles Drugs/alcohol/mediations Developmental level PERSONAL PREFERENCE & HABIT
what are the 10 different hospital diets?
- NPO
- Clear liquid
- Full liquid
- Surgical soft
- Regular
- Dysphagia diets (pureed, honey/nectar thick liquids)
- Low Residue (limit fiber, eat meat, poultry, eggs, milk)
- High fiber
- Diabetic features (low fat and low cal, low sugar)
- Sodium restricted (for heart conditions, kidney function probs)
what are the components of a nutritional assessment? (ADPIE) name details
- -history (assess needs, BMI measure)
- -physical assessment (anthropometitrics–skin fold measure, mid arm circ, BMI, weight, mid arm muscle circ; lab data; appearance)
- -dianosis (assess data–imbalanced nutrition as problem and etiology)
- -implementation (nutritional teaching, monitor nutritional status, stim appetite, assist w eating, provide sup nutrition if needed (enteral feedings etc)
- -evaluation (eval progress, monitor lab values)
In the nutritional assessment, what are you doing as part of history taking and physical assessment?
–History taking
Assessing nutritional needs
Begins with height and weight; BMI
--Physical assessment Anthropometrics -Skin fold measures -Mid-arm circumference -Mid-arm muscle circumference -Body mass index -Body weight Laboratory data Additional clinical signs of altered nutrition -General appearance -Posture -Behavior/mood -Motor/perceptual function -Hair condition -Skin -Face & neck -Lips -Tongue -Teeth -Eyes -Nails
In the nutritional assessment, what are you doing as part of diagnosis?
Assessment data may reveal actual or potential nutritional problems
Imbalanced nutrition as the problem
Imbalanced nutrition as the etiology
In the nutritional assessment, what are you doing as part of implementation?
Teaching nutritional information Monitoring nutritional status Stimulating appetite Assisting with eating Providing supplemental nutrition (Enteral feedings via feeding tube, Percutaneous endoscopic gastrostomy(PEG) tube, Total parenteral nutrition (TPN))
Approaches to stimulate appetite (Small and frequent meals, Environment, Promoting oral care, The set up)
Assisting a client with eating (Individualize, Set up as needed, Call light in reach)
what is dysphagia?
Definition: difficulty swallowing
what to do: Speech evaluation: swallow study
what is TPN? what are the risks?
Total parenteral nutrition (TPN)
–Contains three primary components necessary to maintain nutrition: Proteins, carbohydrates, & fats
Also contains electrolytes, vitamins, and trace elements, insulin, heparin
Risks
- -Risk for sepsis
- -Complications related to insertion of catheter/central IV line
- -Metabolic alterations (hyperglycemia)
- -Fluid/electrolyte, acid/base imbalances
- -Phlebitis
- -Wean slowly off of TPN, high calorie
In the nutritional assessment, what are you doing as part of evaluation? what are the lab values you check?
- -Evaluate progress toward pt. nutritional goals/outcomes
- -Evaluate pt.’s tolerance & adherence to nutritional plan
- -Assessing pt.’s understanding of nutritional plan/diet
–Lab values associated with nutrition
Hematocrit/hemoglobin – decreased in iron deficiency
Serum potassium – depleted in severe nutrition
Albumin – represents protein status
Total Protein – low may indicate malnutrition, protein deprivation
Urea Nitrogen (BUN) – inhibited protein metabolism
what are goals for nutrition?
Goals:
based on attaining specific optimum lab values
Attain or maintain “ideal body weight” (specify)
Eat a certain percentage of meals (specify)
Will attain “physical signs/sx of adequate nutrition” (specify)
what clients are at risk for altered nutrition intake?
anyone who has alterations in ability to: ingets, digest, absorb or has increased metabolic demand
what should the nurse do to stimulate appetite?
Minimize odors
Good oral hygiene
Clean, pleasant environment
Proper positioning and comfort for meal time
Allow food preferences & choices, as possible
Small frequent meals
how do you calculate BMI?
BMI = weight (kg) / height in m2
m2 = which is height x2
what is ethnicity vs race?
Ethnicity–Relates to cultural identification
Race–Physical characteristics, physical traits
what cultural factors affect nursing?
Role of family Folk and Traditional Healthcare Values & Beliefs Common Health Problems Nursing Considerations with each specific cultural group
what are spiritual needs? what are the factors that affect spirituality?
Needs:
Need for meaning and purpose
Need for love and relatedness
Need for forgiveness
Factors affecting spirituality Developmental considerations Family Ethnic background Formal religion Life events
what is spirituality vs religion?
Spirituality–broader, what gives person life, meaning and purpose; allows for transcendence (rise above circumstances)
Religion–practicing, organized by denominations, focused on institutional beliefs
what are the 4 C’s for cultural assessment?
4 C’s cultural assessment
Call–what do you call the problem you are having?
Cope–how do you cope with the prob?
Concerns–what are your concerns regarding the problem?
Caused–what do you think caused the problem?
what are the 7 overarching ethical principles? (what are the main 4?)
Advocacy Autonomy--make own decision Beneficence--good for others without self interest Fidelity--fulfill promise Justice Nonmaleficence--do no harm Veracity--tell truth
main 4 ethical principles:
- Autonomy
- Nonmaleficence
- Beneficence
- Justice
what are the 5 professional values for the nurse in regards to ethics?
Altruism–concern for wellbeing of others
Autonomy
Human dignity
Integrity–code of ethics and standard of practice
Social justice–moral, legal and humanistic principles upheld
Nursing ethics
what are the 4 steps in ethical decision making?
Steps in ethical decision making
- Assessing situation, identify problem
- Planning and weighing alternatives
- Implementing decision
- Evaluating decision
what makes an ethical dilemma?
- -A review of sci data is not enough to solve it
- -Involved conflict between two moral imperatives
- -Answer will have a profound effect on the situation and client
what are the 4 sources of law?
Constitutional Law: serve as guides for legislative bodies.
Statutory Law: laws created by a legislative body or a government agency. Congress.
Administrative Law: rules made in conformity with and to administer Statutory Law.
Usually oversee nursing practice
Common Law: laws derived from common usage, from custom and from judicial decisions or court rulings.
what is litigation? what is a plaintiff and defendant?
litigation–The process of bringing and trying a legal action (lawsuit) in a court.
- Trial court
- Apele Courts–for appeal cases
- -Plaintiff: the person or government bringing action against another
- -Defendant: the person or institution accused of a crime or a tort
what is the State Nurse Practice Act?
Scope of practice defined in each states NPA
- -Broadly defines the legal scope of practice for nursing profession
- -Standards
- –Professional Standards
- –Legal Standards–Rules in nurse practice act are legal standards
what are the 5 purposes of credentialing?
- -Way to demonstrate competence
- -Ways in which professional competence is ensured and maintained
- -Accreditation
- -Licensure
- -Certification
what are crimes vs torts?
–Crimes – is a “wrong” against a person or his/her property – but also considered to be against the public, as well, Punishable by the state
–Torts – is also a wrong committed by a person against another person or his/her property, Punishable in civil court , Does have the potential to be a crime
what are criminal/public vs civil crimes?
Criminal/Public: Deals with Government and Public
Civil: Deals with People and People
what are the different classifications under criminal and civil law?
criminal: felony vs misdemeanor
civil: intentional tort, quasi-intentional tort, unintentional tort
what are examples of intentional Torts and unintentional Torts?
Intentional Torts: Assault & Battery Invasion of Privacy False Imprisonment Fraud Defamation of character
Unintentional Torts:
Negligence
Malpractice
what is the civil law offense Defamation?
Defamation: untrue statements, false statements about patients and coworkers
Slander versus Libel
- -Slander is spoken
- -Libel is written
what is negligence vs malpractice?
Both unintentional torts
Negligence: the failure to act as a reasonably prudent person would have acted in a specific situation.
Malpractice: the failure of a professional to use such care as a reasonably prudent member of the profession would use under similar circumstances, which leads to harm.
what is gross negligence?
Offender is guilty of complete disregard for another’s life, may be tried as both a criminal and civil tort.
what are the 4 circumstances that must be proven in a court of law? think DBCD
- Harm must have occurred to the individual.
- One person must be in a situation where he/she had a duty toward the person harmed.
- The person must be found to have failed to fulfill his/her duty.
- The harm must be shown to have been caused by the breach of duty.
AKA: Duty: obligation to provide care. Breach of Duty: failure to meet standard. Causation: links failure to the injury. Damages: actual injury.
what is a duty? how does it relate to nursing?
A duty is a responsibility to someone
Duty to meet the minimum standard of care in your area of practice
what are breaches in care?
Nurse falls below the standard of care Failure to observe Failure to monitor Failure to report Failure to perform Failure to follow-up Could be breach of commission or omission (did/didn't do it)
what are legal safeguards in place to protect yourself from breaches/legal prosecution?
Legal safeguards:
Contracts Competent Practice Client Education Executing MD orders Documentation Adequate staffing Professional Liability Insurance Risk Management Programs Incident Reports Patient Bill of Rights Good Samaritan Laws
what are important principles of competent practice?
- -Each nurse is required to make sure that his/her background and clinical experience are adequate to fulfill the responsibilities assigned.
- -Respect boundaries of practice
- -Follow institutional policies and procedures
- -“Owning” personal strengths and weaknesses
- -Keeping current
- -Evaluating assignments and refusing those not equipped to safely handle
what is viewed as the legal duty of the nurse?
client education
–document if pt refuses this
what does professional liability insurance do?
Professional liability insurance
- -Protects nurses’ best interests
- -Provides for coverage in limitations of employee coverage situations
- -Covers care or advice given outside of work
what are incident reports?
- -AKA “variance” or “occurrence” reports
- -Tool used to document anything outside of the ordinary that results in or has potential to result in harm to a patient, employee, or visitor. These are used for quality improvement.
–Example: patient fell out of bed, you gave the wrong dose of a med. NEVER write that you made an error in the patient’s chart.
what are the 9 most common errors that result in incident reports/nurse in trouble?
Improp treatment Failure to monitor and report Med errors and reaction Failure to follow policy Quipt error Docu error Adverse effects Breach of confidentiality, caring for clients with HIV
what are some areas that lead to liability?
- -Not questioning orders
- -Medication Administration (right time, right med, right date, right place, right dose, right patient, right documentation)
- -Delegating orders (follow up on orders)
what is the best way to reduce liability?
Excellent documentation
Treat patients/families with respect
what are suspension, revocation and misconduct laws?
–Suspension: a license, and the ability of the license to practice, is held by the BON for the stated period of time and until compliance with BON conditions have been met
–Revocation: a license, and the ability of the licensee to practice, is completely withdrawn. That nurse shall never again be admitted to practice in the state.
Never able to practice again in that state and probably others
–Misconduct: disciplinary hearings are held when charges of misconduct are reported and, upon review by the BON, found unlikely.
what are the 3 levels of liability?
Personal Liability–The nurse is responsible for performing those acts, and only those acts for which s/he is licensed (omission or commission).
Employer Liability–The employer is held responsible for actions of an employee; employee still has personal liability.
Supervisory Liability–The person in a supervisory position is responsible for exercising good judgment in making decisions about assignments and delegation of tasks;
what is the difference between a nurse as a fact witness, vs an expert witness?
FACT: placed under oath, provide first hand knowledge of situation, no assumption, state “i do not remember” when in doubt
EXPERT: May be called by either attorney to explain to the judge and jury what happened based on the records, offer an opinion whether the nursing care met acceptable standards of practice.
what are some ways to reduce risk of being sued?
Proper documentation Treat patients with respect Routinely expand your knowledge/skills Review your job description occasionally Be aware of p/p Look up unfamiliar drugs Question vague or inappropriate MD orders Know the chain-of-command at your institution
what are good samaritan laws?
good samaritan laws give immunity from liability to healthcare providers when they are giving emergency care provided the person uses reasonable, prudent guidelines for care using the resources they have available at the time of the accident.
what is informed consent?
Informed Consent: all risks and benefits should be explained. Alternatives should be offered.
- -Required competency of the client (mentally intact, legally be an adult, child must have legal custody)
- -Must be voluntary (no force)
- -Nurse role is not answer questions, but to identify if they have questions/not. Get the physician if they do
what is confidentiality?
Protection of private information
Individual has right to privacy
HIPAA
what is the nurse’s role in informed consent?
- -patient Must understand available options
- -Must have opportunity to have all questions answered.
- -Nurse signs as witness only (MD explains all to patient/family and answers questions)
what are some types of advance directives?
Types of advance directives
- -Living will
- -Durable power of attorney
- -Providers orders
what are things nurses and health care providers are mandated to report?
Abuse
–Nurses must report any suspicion of abuse
Communicable diseases
- -Report disease diagnoses to state or local health department
- -Ensure appropriate medical treatment for disease (TB)
- -Monitor for common source outbreaks (foodborne, hep A)
- -Plan and evaluate control and prevention plans (immunizations)
- -Identify outbreaks and epidemics
- -Determine public health priorities based on trends
what is allopathic medicine?
Interventions that can be used in acute situations, drugs that can be used in the opposite effect, conventional, traditional
what are complementary health practices?
Interventions that can be used with conventional medicine interventions
People don’t always tell physician about these practices–problem
what are integrative health practices?
Intervention in coordinated therapies with medicine
what are Alternative Therapies?
Lacking biological practicality, ie essential oils, herbs, wellness (not scientific)
what is CAM? what are the 4 categories?
Complementary and Alternative Medicine
1. Complementary Used in conjunction with conventional 2. Alternative Used instead of conventional 3. Traditional More mainstream--like chiropractic, acupuncture, massage therapy 4. Integrative Non mainstream integrated into conventional treatment
what is alternative health (US) care? what is complementary healthcare?
Alternative healthcare–Allopathy or alternative practices, Alternative practices replace allopathic interventions
Complementary health care (US) –Allopathy or complementary health practices, Complementary practices can be joined with allopathic interventions
Who is most likely to use complementary or alternative health practices?
People 30-69 use CAM usually Chronic pain, chronic issues More educated, people use CAM more Higher income = people use CAM more Former smokers use more Adults who were hospitalized in the last year tend to use CAM more frequently CAM used in non-hispanic whites the most 22% hispanic 19% non-hispanic, black
what is the concept of Holism?
Theory and philosophy that focuses on connections and interactions between parts of the whole
what are the most freq used complementary health approaches?
Nonvitamin, nonmineral, natural products (17.7%)
Deep breathing exercises (10.9%)
Yoga (9.5%)
Chiropractic or osteopathic manipulation (8.4%)
Meditation (8%)
Massage (6.9%)
what are some mind-body interventions?
Meditation Prayer Mental Healing Music therapy Art therapy Dance therapy
what are some manipulative and body based intervention methods?
chiropractic Osteopathy Massage therapy Reflexology Martial arts
what are the nursing implications of CAM?
- -Nursing is expanding its knowledge base
- -Certifications in basic holistic nursing
- -Patient education is essential
- -National Center for Complementary and Integrative Health (NCCIH)
