final exam Flashcards
social determinants of health
Social determinant of health defined - factors that impact health other than health services, including location, environment, genetics, income, relationships, and gender.
Neighborhood and built environment, health and healthcare, social and community context, education, economic stability, genetics
effects on social determinants and examples
Health care disparities affect -> the avoidable differences that result from cumulative social disadvantages, including ehealth outcomes, health care assets, coverage and quality of care between groups of people, etc.
Examples: lack of public transportation, access to healthcare, exposure to environmental hazards, social support network, etc.
Poverty and unemployment are factors of socioeconomic status but is a social determinant of health
palliative care
Services provided to clients to promote comfort while in the last stages of life. Services can be received during active treatment. A treatment approach that is focused on the management of symptoms of chronic or life-threatening illnesses while maintaining the highest level of quality of life possible for the client.
Palliative care has been shown to improve a client’s quality of life, reduce their time in the hospital, improve their satisfaction, and be given to those who are experiencing a severe medical illness and particularly those reaching the end of life.
primary prevention
Primary - focuses on the act of intervening before the negative health effects occur. Working to decrease the risk for development of medical conditions by changing behaviors or minimizing exposures.
examples of primary prevention
Vaccinations, changing risky behaviors such as tobacco use, banning harmful substances.
Teaching bicycle safety to school age children, discussing the prevention of sexually transmitted infections with a community group, distributing brochures about heart health at a center for older adults
secondary prevention
is done to reduce the impact of the disease or injury, and to limit the disability. Early screenings to detect a disease process before it progresses to cause symptoms or complications.
examples of secondary prevention
Blood pressure measurement to detect hypertension, blood cholesterol levels, cancer screening such as mammograms, Pap test, routine colonoscopies.
Scheduling a client for a screening for prostate cancer, checking all clients for depression at well client check ups
tertiary prevention
Tertiary - focuses on controlling the chronic effect of a health issue that has already occurred, and/pr restoring the individual to a level of optimal functioning.
examples of tertiary prevention
Self care, rehabilitation (OT and PT)
Implementing bladder retraining with a client who has a spinal cord injury, nutritional counseling for a client who has diabetes mellitus, leading a support group for clients who has post traumatic stress disorder
quaternary prevention
a focus on protecting clients from the excessive use of medical interventions that can cause more harm than good
what is a health record
a collection of health information and the data about an individual client’s health
components of a health record
Includes: patient demographics, medical history, current medications, allergies (if any), physical examination findings, diagnostics and their results, progress notes, treatment plans, discharge summaries, immunization data.
- Treatment notes, progress notes, discharge summaries, admission paperwork, documentation of treatment
the novice to expert stages of nursing
- Novice - a beginner with little or no experience
- Advanced beginner - can demonstrate basic skills but continues to need the support and guidance from a mentor
- Competent - individual can plan, make decisions, and perform job responsibly and efficiently
- Proficient - demonstrates advances decision making, knowledge, resourcefulness, flexibility, and problem solving
- Expert - role models deep knowledge and skills, teaches others, and multitasks effortlessly and fluently
aromatherapy
the act of breathing in a scent of a natural plant extract
lavender in aromatherapy
Lavender - inhalation of this and bergamot during radiation therapy as means to reduce anxiety; massaging lavender with tea tree oil is a sleep aid, inhalation of lavender and ginger in a 2:1 ratio can increase salivation
steps to evidence based practices
Identify a problem: ask a question
Search credible sources of evidence: look for factual information
Evaluate findings: review the information
Implement recommendations: change the interventions
Review their effectiveness: do the new interventions improve results?
Disseminating the results: share the findings with others
what is an incident report
This is a report that is a documentation of errors and the factors leading up to and including when an error occurs in the healthcare system
- Every system typically has a specific place for these and a specific way of doing them
the most acceptable two client identifiers
full name and date of birht
teach back method
Teach back is conducted by asking the client to repeat or demonstrate educational information back to you. This method allows the nurse to confirm that the client received the information correctly
Ex: teaching a client how to take their blood sugar. Then the nurse asked the client; can you tell me how you would take your blood sugar at home?
lecture teaching method
Lecture - allows the client to gain comprehension and knowledge
group instruction teaching method
Group instruction - involves teaching two or more clients who are obtaining the same learning material simultaneously
individual instruction teaching method
Individual instruction - occurs when the education session engages only the learning and the teacher and is the most common form of client education
Allows for active engagement of feelings, attitudes, perceptions, and values (affective)
question and answer method of teaching
Question and answer: allows teach-back, feedback, and evaluation
the steps of the teaching process
Assessment, analysis, planning, implementation, and evaluation
difference between ophthalmic and otic medication administration
Ophthalmic - the process of putting medication directly into the eye to treat a variety of eye conditions
after applying medication apply pressure on the nasolacrimal duct
Otic - the process of putting medication directly into the ear to treat a variety of conditions
- Make sure it is at room temp, make sure to shake well before use, make sure to irrigate the ear if dirty or blocked
pharmacodynamics
the study of how a drug works, its relationship to the drug concentrations, and how the body responds.
trough blood level
Trough blood level - the lowest level of the drug when in the human’s body
etic knowledge
an outsider’s viewpoint of a culture
emic knowledge
a cultural insider’s viewpoint of a culture
inclusion
An environment that embraces individual differences to allow individuals to bring their whole selves and identities to display their full capacity
normal grief
Normal grief - also known as uncomplicated grief; caused by the death of a loved one or the ending of a relationship
anticipatory grief
Anticipatory grief - grief that is experienced before the loss of someone or something
prolonged grief disorder
Prolonged grief disorder (PGD) - previously known as complicated grief; experienced by clients who are unable to accept the death of a loved one
disenfranchised grief
Disenfranchised grief - grief related to a relationship that does not coincide with what is considered by society to be recognized or justified as a loss
- Ex: Death of a pet, miscarriage
NURSE mnemonic
Name: identify what the client just stated, or the emotion expressed by the client
Understand: demonstrate understanding by recognizing the client’s feelings and providing an opportunity for the client to discuss their feelings
Respect: voice your respect for the client under these circumstances
Support: inform the client that you are available for him or her
Explore: ask open-ended questions to extend the conversation and provide a more detailed expression of the client’s feelings and beliefs
general adaptive syndrome alarm stage
1st stage
Alarm – when the central nervous system becomes aroused, and the body defense mechanisms are mobilized. Then hormones are released, and the body goes into fight of flight mode
general adaptive syndrome resistance stage
2nd stage
Resistance - the body resists and seeks to counter the stress. The parasympathetic nervous system attempts to return bodily functions back to a state of homeostasis. The body remains on alert while hormonal and other bodily functions return to normal and as the body repairs any damage caused by the threat.
general adaptive syndrome exhaustion stage
3rd and final stage
Exhaustion - the body can no longer defend itself against the stressor. In this stage, when the body’s capacity to withstand or adapt to the stressor becomes depleted and the individual’s resources are exhausted, prolonged exposure to stress may result in illness or disease.
acute stress
Acute - the most common and frequent type of stress. Usually brief and can be positive or negative. It causes an immediate reaction and triggers the fight or flight response
chronic stress
Chronic - a disabling condition that occurs when stress levels are heightened, constant, and prolonged.
physiological stressors
Generally associated with injury or illness, such as things like exposure to extreme temperatures, trauma, injury, illness, or pain.
- The body’s reaction is immediate and is necessary for survival.
acute stress disorder
Acute stress disorder - an intense and dysfunctional reaction to a traumatic event that lasts less than a month
- Ex: death of a loved one, threat of serious injury to themselves or others, exposure to war or other acts of violence.
posttraumatic stress disorder
Posttraumatic stress disorder - A prolonged and heightened stress reaction to a traumatic event that lasts more than a month. Typically follows a traumatic event such as an accident, sexual abuse, or a naturally occurring disaster
irritable bowel syndrome
Irritable bowel syndrome - a common GI condition manifested by symptoms of abdominal discomfort, cramping, bloating, diarrhea, and/or constipation.
special considerations for nail care
Do not do nail care for someone who has diabetes, assess skin integrity, cut in a straight line, be cautious of bleeding disorders
Clean cuticles and put lotion on them
Woman with nail polish - take it off with nail polish remover with no acetone
nociceptive pain
Nociceptive - pain that is felt in the tissue, an organ, a damaged part of the body, or a referred pain
- Usually localized and described as throbbing or aching
neuropathic pain
Neuropathic - nerve pain that arises from the somatosensory system, described as intense, burning, and shooting
- Associated commonly with: spinal cord injuries, cancer pain
acupuncture
A professional procedure using long, thin, sterile needles to penetrate the skin and stimulate, by hand and/or electrically, anatomical points in the body to improve short and long-term physical function
body image
A person’s perceptions, feelings, and thoughts about their body and is usually conceptualized by perceptions related to body shape, size, and physical attractiveness
hospice care
Care services for clients and families that focus on comfort and support; not curative when it is determined the client has less than six months to live
- Generally provided in a home when treatment will no longer cure or control an illness
postmortem care
Physical care provided after the client has died; includes washing the body, recording the time or death, documenting who was notified of the death, accounting for the client’s possessions, removing invasive devices, and placing identification tags on the body.
nutritional supplements -> folic acid
Used when pregnant to prevent spina bifida in the developing fetus
Important for early fetal development of the brain and spine
vitamin C and iron coordinating with eachother
When taking Iron clients should also take vitamin C because it helps to absorb iron
Donning PPE
hand hygiene
gown
mask
eye goggles or face shield
gloves
doffing PPE
remove gloves
face shield or eye goggles
gown
mask
hand hygiene last
Erikson’s stages of psychosocial development
Infancy - trust versus mistrust
Preschool - initiative versus guilt
School age - industry versus inferiority
Adolescence - identity versus role confusion
Young adulthood - intimacy versus isolation
Middle adulthood - generativity versus stagnation
Maturity - integrity versus despair
active listening
Focuses on the client’s verbal and nonverbal messages
In this the nurse will show that they are paying attention and will then ask open ended questions to get the client to continue to talk
NPO
- nothing by mouth
regular diet
Regular diet - consists of healthy food coming from all of the food groups such as fruits, vegetables, grains, protein, and dairy sources
soft diet
Soft diet - foods that are soft, easy to digest, low in fiber, and can be swallowed without difficulty
pureed diet
Pureed diet - consists of foods that are soft and smooth and do not need to be chewed
full liquid diet
Full liquid diet - a diet that contains only fluids, foods that are liquids, and foods that are liquids at room temperature, such as ice cream
clear liquid diet
Clear liquid diet - contains only clear liquids, such as broth, gelatin, and water
abbreviations
BID = twice a day
AC = before meals
HS = at bedtime
PRN = as needed
Q_H = every _ hours
PC = after meals
TID = three times a day
QID = four times a day
conversions
King Henry Died By Drinking Chocolate Milk
- Kilo, hecto, Deka, Base (meter, liter, gram), deci, centi, milli
how to move bigger or smaller with conversions
If going bigger the decimal moves the the left, if going smaller the decimal moves to the right
PQRST
P - what were you doing when the pains started
Q - describe what you pain feels like
R - show me the location of your pain
S - on a scale of 1-10 how is your pain
T - when did the pain first begin? Have you experienced it before?
the joint commission
Is an independent, non-profit organization that accredits healthcare organizations in more than nine different types of healthcare settings
Accredits based on; their safety performance, policies, procedures, practices, and outcomes
press ganey
This is a survey that is sent to clients who have recently received care at the participating facility. The survey covers things like communication with healthcare professionals, waiting times, care, and overall satisfaction
what is health promotion
the process of enabling people to increase their control over and improve their health
self-care practices
Is of the utmost importance that clinicians engage in self care and practices to maintain their emotional well being, and preventing burnout, moral distress, and or the lack of compassion
- Burnout is a progressive loss of idealism, energy, and purpose experienced by people in the helping professions as a result of the conditions of their work (we are all susceptible to this)
modifiable versus nonmodifiable risk factors
Modifiable - behaviors and actions that affect a client’s risk for developing a disease
Non-modifiable - risk factors that cannot be changed like; age, gender, ethnicity, race, family history
OARS
open-ended questions
affirmations
reflective listening
summarizing
PIE
problem
intervention
evaluation
SOAP
Subjective - symptoms that the client describes (pain level, feelings)
Objective - symptoms that are clinical impressions that the provider can see, hear, touch, smell, or measure (bp, fever, vomiting)
Assessment - combines the subjective and objective information to help arrive at a nursing diagnosis
Plan - the detailed steps to treat clients and the need for consultation or additional testing to address client needs
EMTALA
Emergency Medical Treatment and Labor Act (EMTALA)
- The act passed that says that a healthcare organization cannot pass off a client based on their inability to pay or lack of insurance
- Ensures that any individual who comes in for care will at a minimum receive a medical screening examination and treatment is stabilized.
Where should a patient hand-off report take place?
At the patient’s bedside whenever possible to ensure ongoing communication between the staff and the client
massage therapy
Is an ancient manual therapy of manipulating soft tissue for relief from pain and other conditions.
- Includes: rhythmic pressure, friction, or kneading of: skin, muscles, tendons, ligaments, or the fascia
- Can lead to adverse effects like: blood clots, nerve injuries, bone fractures
PICOT
Population - who is the target population
Intervention - what is the intervention being used
Comparison - is there a control group or a comparison
Outcome - what are the outcomes
Time - what is the time frame or follow up time (not required)
health literacy and low version
Health literacy - the ability to process and comprehend basic information necessary for the client to make appropriate health care decisions.
All information should be presented at a 6th grade level
contact transmission
Contact - occurs when microorganisms move form an infected person to another person (direct contact)
droplet transmission
Droplet - occurs when airborne droplets from the respiratory tract of a client travels through the air and into the mucosa of the host or the other person (indirect contact)
airborne transmission
Airborne - occurs when small particulates move into the airspace of another person
stages of infection
Incubation - an infection enters the host and it begins to multiply, before symptoms appear
Prodromal - when the client begins to have symptoms
Acute illness - manifestations of the specific infectious disease process are obvious and may become severe (worst stage)
Decline - the manifestations begin to wane as the degree of infectious disease decreases
Convalescence - the client returns to a normal or “new normal” state of health
droplet precautions
The infection preventions needed to protect a client who has something where the spread of pathogens can occur through close contact with respiratory secretions
teratogenic medications
These are medication that are known to cause fetal defects, pregnancy loss, developmental disabilities, or prematurity
Ex: cocaine, alcohol, lithium, NSAIDs, ACE inhibitors, gentamicin, tetracycline
Self-concept congruence vs incongruence
Self-concept congruence - occurs when a person’s ideal self is consistent with their actual life experiences
Self-concept incongruence - occurs when a person’s ideal self is not consistent with their actual life experiences
identity self concept stressor
Identity - life events that threaten self-concept like; gender dysphoria, being laid off, losing one’s career, divorce, death or a spouse
body image self concept stressor
Body image - societal attitudes about physical attributes, appearance, and performance that can impact a client’s self-perception of their body image
role performance self concept stressor
Role performance - this refers to the individual’s perception of how well they perform in roles. There are four type: role conflict, role ambiguity, role overload, role strain
the four types of role performance
Conflict - faced with two or more expectations and are unable to meet them at the same time
Ambiguity - refers to the lack of clarity in understanding the actions that are needed to be taken to achieve any proposed goals
Overload - when roles and responsibilities placed are greater than the individual can effectively manage
Strain - when they have difficulty meeting the responsibilities of a particular life role when incompatible needs are placed on them
self-esteem as a self-concept stressor
Self-esteem - a person’s subjective sense of their own worth and value, essentially how much they believe they are capable and deserving of respect
client advocacy
Being able to speak up for the clients’ needs when the client is unable to speak for themself and also being able to support the clients to helping them make choices for their own health
- The nurse specifically needs to be able to communicate the client’s wishes or beliefs. They communicate with the healthcare providers and help with talking with families if needed. The nurse also helps to discuss the best options for that client specifically
swanson’s theory of caring
- The theory views caring as a process of five categories through which a person goes to achieve overall well being
Maintaining belief: faith and recognizing it
Knowing: how does it all fit in with the bigger picture
Being with: being able to be with the client physically and emotionally
Doing for: what skills and touch can you do (changing sheets?)
Enabling: be able to enable them to do as much as they can for themselves
cultural bias
Knowing our own bias can enhance our cultural awareness and in turn help us to take better care of clients
health disparities
They involve health outcomes that may be greater or lesser among different socioeconomic populations
- Vulnerable populations are the groups of people that are at higher risk for poor outcomes from barriers to social, economic, and environmental resources, including limitations or disability.
Kubler-ross stages of grief
Denial - the client refuses to believe the truth and this helps to lessen the pain of the loss
Anger - client is trying to adjust to the loss and is feeling severe emotional distress, often asking “why me?” and suggesting “it isn’t fair”
Bargaining - usually involves bargaining with a higher power by making a promise to do something in exchange for a different, better outcome
Depression - reality starts to set in, and the loss of the loved on or thing is deeply felt
Acceptance - the client still feels the pain of the loss but realizes that all will be alright
fight or flight response
When a situation is determined to be stressful, the hypothalamus secretes corticotropin releasing factor (CRF) which activates the sympathetic nervous system (SNS) to release norepinephrine, epinephrine, and dopamine also known as the “fight or flight” response which causes an increase in heart rate, blood pressure, cardiac output, dilation of bronchial airways, pupil dilation, and an increase in blood glucose levels.
melatonin
The pineal gland manufacture melatonin which is a natural substance that tells the body when it is time to go to sleep
end of life physiological signs
Physiological changes at the end of life follow a familiar pattern of signs and symptoms. The terminal phase of a client’s life is characteristically referred to as “actively dying” or “imminent death.”
Dyspnea: shortness of breath. Retention of secretions in the respiratory tract, also known as “death rattle”. Cheyne-Stokes respirations: an irregular respiratory rate fluctuating between several quick breaths and periods of apnea
Pain at the end of life: Experienced by nearly 60% of older adult hospice clients who have cancer. Occurs because of nerve injury, organs being stretched and compressed, and/or bone pain
Temperature alterations at the end of life: Ability of the nervous system to regulate body temperature diminishes, causing clients
to experience both increased and decreased temperature. Also caused by infection, cancer, and cancer therapy. Mottling occurs hours or days before death, with the upper and lower extremities becoming cool to the touch. Mottling occurs as a result of the heart’s inability to pump blood effectively, leading to decreased blood perfusion throughout the body.
Vision and hearing at the end of life: clients may experience hallucinations or report hearing or seeing those who have already died
functions of macros
Macronutrients include protein, carbohydrates, and fat. They are eaten in large amounts, are the primary building blocks of any diet, and provide the body with the energy needed to function
what is beneficence
the principal that guides nurses to act in the clients best interests by promoting well-being and preventing harm
integrity
when the nurse admits that they have administered the wrong medication
drug calculations
desired/have
what is nonmaleficence
the agreement to not do harm to patients
autonomy
the ability to make your own decisions about what to do
justice
giving fair equal treatment no matter who it is
fidelity
the faithfulness towards a patient, cause, or belief
veracity
truth telling; reporting errors that could harm patients, even is no harm has occurred
