Final Flashcards
What is cultural competence?
An attitude of openness, respect for, and curiosity about different cultures, values, and traditions
Involves consideration and critical analysis of health disparities an attempt to make nursing adequate among all cultures
What is cross-cultural or transcultural nursing?
Any encounter a nurse has with a patient from a different culture
What is institutional, cultural competence?
When a company has the capacity to:
Value diversity
Conduct self-assessment
Manage dynamics
Acquire knowledge
Adapt to diversity
What is cultural humility?
Acknowledging that everyone’s views are culturally influenced
And that our own personal beliefs are not better than others
What is cultural safety?
Culturally appropriate health services to disadvantaged groups
While maintaining dignity and avoiding institutional racism, assimilationist and repressive practices
What is ethnocentrism?
And assumptions that everyone shares your cultural views, and/or you believe your culture is superior to others
What is subculture?
Group, sharing some practices, language, or other characteristics in common within a larger society that does not share those characteristics
Example: high school is the larger society, subculture would be the different clicks: goth, athletes, theater, etc
Example 2: race - it is a social construct, not a biologic entity
What is a health disparity?
Significant gap and health status between overall American population and people of specific ethnic backgrounds
Examples are people of different, ethnic backgrounds are more prone to comorbidities, such as cancer, heart disease, diabetes, HIV, AIDS, etc
What does Leininger’s theory include regarding transcultural nursing?
-culture care accommodation
-culture care restructuring
-Acculturation
-Cultural blindness
-Cultural imposition
-Cultural taboos
What are legislative issues regarding end of life?
DNR orders
Advanced directives
Assisted suicide legislation
Living will
Proxy directive
Durable power of attorney
What are the different awareness context regarding death and dying?
Closed - patient is unaware of the terminal state, but others are aware
Suspended - patient suspects what others know, and attempts to find out details about their condition
Mutual pretense - patient, family and healthcare professionals are aware the patient is dying, but pretend otherwise
Open - patient family and healthcare professionals are aware the patient is dying and open the acknowledge the reality
Where are the different settings that palliative care can take place?
Hospital
Skilled nursing facility
Outpatient
What is hospice care?
Group of professional caregivers and coordinated programs to help take care of patients with serious progressive illnesses with no cure
Hospice care is anticipated for no more than six months
What is managed her in hospice care?
Pain management
Patient support
Family support
Home care of dying
Bereavement
Research and education
Spiritual
Services
Supplies (bed, wheelchair, Walker, air tank, etc)
Where can hospice services be provided?
Home
Hospital
Nursing home
Hospice home setting
Assisted living
What are the four levels of hospice care?
1) routine home care
2) inpatient respite care (caregiver break)
3) continuous care
4) general and patient care
What is an advance directive?
Written document that allows competent people to document their preference regarding:
-use of medical treatment at end of life
-Specifically their preferred setting for care
-Communicate other valuable insight into their values and beliefs
What are proxy directives?
Appointment and authorization of another person, to make medical decisions on behalf of the person who created the advance directive when he or she can no longer speak for him or herself.
What is the death vigil?
(Signs death is coming)
Withdrawal
Sleeping longer
Somnolent
Increased intervals between respirations
Decrease blood pressure
Mottling of the skin
What is grief?
Personal feelings that accompany an anticipated or actual loss
What is mourning?
Individual, family, group, and culture expression of grief and associated behaviors
What is bereavement?
Period of time during which morning of a loss takes place
What are nursing interventions when death is imminent
-Decisions about level of care
-Comfort measures only
-Advance directives
-Artificial nutrition and hydration
-CPR?
-euthanasia and physician assisted suicide?
Will a dying patient go through all of the grieving steps in order?
No, they may go through one or all, may go out of order, and may return to one in a later time
What is palliative care?
Focus on the relief of suffering for clients with serious illness
Best possible quality of life not only for clients, but for their family as well. Giving them their dignity
Can before for: a cute, serious, life-threatening, illnesses, or progressive chronic illnesses
What is the focus of palliative care?
Controlling symptoms
Coordinating care
Reducing unnecessary tests and futile interventions
Ongoing conversations with patient and family
What services are included for hospice care?
Physician
Nursing
Physical therapy
Occupational therapy
Speech/language pathology
Medical social services
Hospice aide services
Homemaker services
Medical supplies (drugs, biologic, and Medical appliances)
Counseling (diet, bereavement, spiritual)
Short term and patient care for respite care, pain control, and symptom management
What does “ staging?” Mean regarding cancer
Has it spread?
TNM: tumor, nose, metastasize
T = extent of the primary tumor
N = absence or presents and extent of regional lymph node metastasis
M = absence, or presence of distant metastasis
What does “ grading” mean regarding cancer?
Classification of the tumor cells
-To what extent to the cells resemble the original tissue
-Grade 1- through four
1: closely resembles the tissue of origin
4: do not resemble the tissue of origin
What is a biopsy?
Obtaining a tissue sample of a cell that is expected to be malignant
What are the different types of biopsy
Excisional - surgical removal of the tumor (done when tumor is easily accessed; skin, breast, GI, respiratory tract)
Incisional - performed if tumor is too large to be removed
Needle - for masses easily accessible (Breast, thyroid, long, liver, kidney)
What surgeries can be completed as a prophylaxis for cancer
Colectomy
Mastectomy
Oophorectomy
What is radiation regarding cancer?
It is used to cure localized cancers, and can be used in combination with other therapies
Can be used in a positive way to try and shrink the tumor
What is a lethal tumor dose?
Well eradicate 95% of the tumor, but preserve normal tissue
What is fractionated radiation regarding cancer?
Doses of radiation, delivered overtime until total doses delivered
What is teletherapy radiation regarding cancer?
External beam of radiation
This is most commonly used
It’s targeted
What is Brachytherapy radiation regarding cancer
Implanted seeds, beads, or Catheters
Delivers a high dose of radiation
What are some radiation complications
Toxicity
Alopecia
Stomatitis
Thrombocytopenia
What do nurses need to assess during radiation therapy?
Skin
Oropharyngeal mucosa
Nutritional status
General well-being
What are safety precautions regarding brachytherapy radiation?
Private room
Posting signs
Dosimeter badge
No pregnant staff members / visitors
No children
Limit visits to 30 minutes per day
Visitors maintain 6 feet away
What is chemotherapy?
Used to attempt to destroy tumor cells by interfering with the cells functioning (their ability to replicate)
What are alkylating agents (regarding chemo)
Alters DNA structure by miss reading the DNA code
What are Nitrosoureana agents (regarding chemo) ?
Similar to alkylating, but they cross the blood brain barrier
What are topoisomerace I inhibitor agents (regarding chemo) ?
Induce breaks in the DNA strand by binding to enzyme and prevent the cells from dividing
What are antimerabolite agents (regarding chemo) ?
Interfere with a bio synthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis
What are antitumor antibiotics (regarding chemo) ?
Interfere with DNA synthesis by binding DNA and prevent RNA synthesis
What are mitosis spindle poisons (regarding chemo) ?
Arrest metaphase by inhibiting mitotic tubular formation, and inhibiting, DNA and proteins synthesis
What are hormonal agents (regarding chemo) ?
Binding two hormone receptor sites that alter cellular growth
What do nurses need to do during chemotherapy?
-assess fluid and electrolyte balance
-Modify risk for infection and bleeding
-Administer chemotherapy
-Protect caregivers
What are the different types of bone marrow transplant?
-Allogeneic: related donor other than patient, donor may be related donor or matched unrelated donor
-autologous: from the patient himself /herself
-Syngenic: from identical twin
What are nursing interventions pre-bone marrow transplants?
Pre-transplantation:
-nutritional assessment
-Extensive physical exam
-Organ function test
-psychological evaluation
-patient support system 
What are nursing interventions during bone marrow transplants?
-Vital signs
-Pain
-Comfort
What are nursing interventions post- bone marrow transplants?
Ongoing assessment for several weeks
What are gene targeted therapies regarding cancer?
Tumor directed therapy: introduction of a therapeutic gene (suicide gene) into tumor cells and attempt to destroy them
Active immunotherapy : administration of genes that will invoke the antitumor responses of the immune system
Adoptive immunotherapy : administration of genetically altered lymphocytes at a program to cause tumor destruction
what are risk factors for breast cancer?
Gender (being a woman)
Age (greater than 40)
Nulliparity
Having your first child after 30
Early menarche
Late menopause
Long term estrogen replacement
90% are NOT related to heredity
However, risk doubles with 1st degree family member
How do you assess for breast cancer?
-Firm lump or thickness in breast (typically painless)
-spontaneous nipple discharge (can be bloody, clear, or serous)
-asymmetry of breast
-Nipple retraction
-Nipple scaliness
-Enlargement of auxiliary or super clavicular lymph nodes
How do you diagnose breast cancer?
Mammogram
Biopsy
Estrogen/progesterone receptor assay
Lab test
Bone scan/CT/PET scan
What are surgical interventions for breast cancer?
Lumpectomy
Mastectomy
Mammoplasty
Bone marrow transplant