final exam Flashcards
Routine admit
planned
scheduled in advance
Example: knee replacement surgery
scheduled inductions
Emergency admit
Not planned
Occur because of an injury, sudden change in condition, need for immediate treatment
Nursing assessment
Vital signs, height and weight
Medications and allergies
ID for the patient and explaining pt. verification
Instruction on collecting urine for measurement etc.
Bathing and walking assistance
Dehumization
Process of depriving a person of personality, spirit, privacy and other human qualities.
Handle procedures and questions with the utmost tact and respect.
Emphasize the clients strengths rather than weakness.
Discharge Planning
Process by which the client is prepared for continues care outside the healthcare facility.
Arranged by discharge planner (LPN or RN)
Discharge planning starts as soon as the patient is admitted.
Discharge must be ordered by the physician
The plan takes TEAMWORK.
Teamwork is often planned out in meetings
Physicians office should receive the discharge plan and instructions
discharge components
Follow up care Equipment needed: Walker, Wheelchair, Oxygen etc. Special Diet Medications: New, Same or D/C Special procedures Family willingness Referrals Special instructions Documentation of what was taught and what was understood
Physicians office should Know
Time frame of follow up care 1 week, 2 weeks, etc. Diagnosis or reason for hospital stay Change in medications Procedures or follow up tests ordered. Any dietary restrictions Dressing changes, Referrals for home care, hospice care etc. Special instructions
advance directive
Provides an opportunity for clients to determine in advance their wishes regarding life sustaining treatment and other medical care so that their significant others will know what decisions clients desire. Three types: Living will DPOA for Healthcare Five wishes
six c’s
Clear Coherent Concise Correct (accurate statements) Courteous Confident
effective communication
Choose the correct medium
Understand the reason for the communication
Outline what you want to accomplished
Outline the benefits of a response
Create credibility and acknowledge respect for the person receiving the communication
how do you send mail with letter of termination
certified
if you make a mistake/error in documentation how do you correct it
single line intial and date
Advantages of the EHR
Can flag the patient for recall Files retrieved more quickly Takes up less space Analysis reporting is easier Charts are not misplaced
Cost vs savings
Improves diagnosis coding and procedure coding
Reduces labor – staff does not have to pull chart and re-file it
Lowers malpractice premiums
Storage space dramatically reduced
Supplies reduced – charts, labels, etc.
How long do you keep a record for
7 years in Michigan – Statute of Limitations
5 years after the patient dies
Usually the chart is moved to a “deceased” area
what is profession
Is an act of declaring belief, faith, or opinion requiring special knowledge or training.
Professional standing can not take place without training, practice administration and recognition by qualified state approved agencies and governing bodies.
Professionalism can be thought of a distinctive way of providing a service that has its own science of reasoning and practice.
what is occupation
provides a product or service.
what is the shorter version of profession
service has science of reasoning, formal training, certification, or license.
relationship stops when the pt hasn’t been seen in
three years
3 most important factors in health care are
Cost
Quality
Access
frazzled employee
“An employee who argues with a demanding patient not only upsets the patient more, but also becomes just as tense and out of control. An employee must be able to adapt to various situations that arise in a medical office” (Andress, 2009, p. 40).
types of ambulatory health care
Private clinics Urgent care centers Rural Health Services Ambulatory Surgery Centers Dialysis centers Infusion Therapy School Health Services Retail Clinics Emergency Dept.
role of LPN in ambulatory health care
In Ambulatory care settings nurses have the opportunity to use many different skills learned.
In addition to routine client care, nurses in ambulatory settings perform many other duties not usually performed by nurses in acute-care setting.
LPN’s who work in ambulatory care centers provide direct assistance to Physicians or other types of Providers
telephone triage is defined as
Defined as: an interactive process between the nurse and the patient that occurs over the phone and involves identifying the nature and urgency of client healthcare needs and determines the appropriate disposition (rutenberg & Greenberg, 2012)
the focus of telephone triage
Telephone triage is focused on the assessment and disposition of symptom based calls rather than message taking.
Typically performed by the Nurse. Recognized and supported by most state boards.
It does not involve making a diagnosis
Nursing or Medical
Interview to establish “Chief complaint”
Ask appropriate questions for the problem or symptoms Reason for today’s visit Onset of symptoms Description of the symptoms Duration Intensity Frequency History Accompanying signs and symptoms Precipitating/Alleviating factors Progression
is telephone triage involve making a diagnosis
no
Autoimmune diseases occur
when there is a breakdown of tolerance; immune system identifies its own proteins as foreign and mounts a response to destroy these self-proteins
Examples: idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), acute rheumatic fever, type 1 diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, Graves’ disease, and Hashimoto’s thyroiditis
are mediated by IgE reacting to common allergens, such as dust, pollen, animal dander, insect stings, or various drugs
Type 1
are mediated by antibody reactions
Can occur with a mismatched blood transfusion or as response to various drugs
Type 2
result in tissue damage resulting from precipitation of antigen-antibody immune complexes
Can occur with autoimmune reactions,
type 3
Delayed hypersensitivity reactions result from immune cells migrating to the site of exposure days after the exposure to the antigen
Can occur with contact dermatitis, measles rash, tuberculin skin testing, or various drugs
type 4
Inflammatory response
redness, heat, swelling
Autoimmune disease: immune system unable to recognize itself; mounts an immune response against its own proteins
Damage from antibodies and immune complexes directed against one/many organs
Lupus
S/s of lupus
Fatigue, malaise, fever, anorexia, nausea, and weight loss
Arthralgias and myalgias
Joints often swollen, tender, stiff, and painful
Rash and photosensitivity
Butterfly-shaped rash across the bridge of the nose and the cheeks
Inflammation of the retina can result in sudden-onset blindness
medical treatment for lupus
Analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials, corticosteroids
Cytotoxic agents suppress the abnormal immune response
ways to admister chemotherapy
oral, intramuscular, intravenous, intracavity, intrathecal
A healthy response
May be associated with grieving before a death actually occurs or when the reality that death is inevitable is known
adaptive grief
Usually related to a loss or death
May be a healthy or an unhealthy response to the grief process
Patient and family members can experience anticipatory grieving
anticipatory grief
After an actual loss or a death occurs
reactive grief
Grief that is delayed or exaggerated
May relate to a real loss or a perceived loss
May occur in the absence of anticipatory grief,
dysfunctional grief
sensory changes
Include decreasing pain and touch perception, blurred vision, and decreasing sense of taste and smell
Blink reflex lost eventually; patient appears to stare
The sense of touch decreases first in the lower extremities in response to circulatory changes
Hearing is commonly believed to be the last sense to remain intact during the death process
Assume that the patient can hear and understand
Body gradually relaxes until all function ends
Generally, respirations cease first
The heart stops beating within a few minutes
The physician is responsible for ordering discontinuation of life support if it is in use
Physician also responsible for pronouncement of death in most situations
Type 1 diabetes
Absence of endogenous insulin
Formerly called juvenile-onset diabetes because it most commonly occurs in juveniles and young adults
An autoimmune process, possibly triggered by a viral infection, destroys beta cells, the development of insulin antibodies, and the production of islet cell antibodies (ICAs)
Affected people require exogenous insulin for the rest of their lives
Type 2 Diabetes
Inadequate endogenous insulin and body’s inability to properly use insulin
Beta cells respond inadequately to hyperglycemia; results in chronically elevated blood glucose
Continuous high glucose level in the blood desensitizes the beta cells; they become less responsive to the elevated glucose
More common in adults; increasing in children
Controlled by diet and exercise; may require oral hypoglycemic agents or exogenous insulin
role of insulin
Insulin stimulates active transport of glucose into cells
Promotes fatty acid synthesis and conversion of fatty acids into fat, which is stored as adipose tissue
Enhances protein synthesis in tissues and inhibits the conversion of protein into glucose
risk factors for diabetes
obesity
hx if gestational diabetes
sedentary lifestyle
metabolic syndrome
type 1 is an what?
autoimmune disease
long term complications of diabetes
retrinopathy
neuropathy
nephropathy= kidney damages
all pt with type 1 need
insulin injection
type 2 will eventually some
how are insulin given
all insulins can be given sub q
only regular insulin can be given IV
premixed insulin’s contain
Contain both Regular and NPH insulin
regular first and N second for mxing
indications of diabetes
One or more of the following criteria on two separate occasions is considered DM
Polyuria, polydipsia, polyphagia, unexplained weight loss plus random glucose level >200 mg/dL
Fasting serum glucose level >126 mg/dL (after at least an 8-hour fast)
Two-hour postprandial glucose level >200 mg/dL during oral glucose tolerance test (OGTT) under specific guidelines. Test must use a glucose load of 75 g of anhydrous glucose dissolved in water
Hypoglycemia s/s
glucose levels falls 45-50
shakiness, nervousness, irritability, tachycardia, anxiety, lightheadedness, headache, hunger, tingling or numbness of the lips or tongue, and diaphoresis
When treatment is delayed or Bg falls over several hours: drowsiness, irritability, impaired judgment, blurred or double vision, slurred speech, headaches, and mood swings progressing to disorientation, seizures, and in severe cases unconsciousness leading to coma
treatment of hypolycemia
Give patient 10 to 15 g of quick-acting carbohydrates (e.g.1/2 cup milk or orange juice).
Repeat every 15-30 minutes until blood glucose is >70 mg/dL for adults, 80 to 100 mg/dL for older adults and children
If patient is unable to swallow, an IM or subcutaneous injection of 1 mg of glucagon or an IV dose of 50 mL of 50% d
structures in the pituatory include
Hypothalamus Pituitary gland Thyroid gland Parathyroid glands Adrenal glands Pancreas
function of pancreas
An accessory gland for digestion Exocrine and endocrine functions Exocrine function: Secretes digestive enzymes (amylase, lipase, trypsin) Pancreas secretes enzymes into the duodenum through the pancreatic duct Endocrine function: Secretes hormones (insulin, glucagon, somatostatin) from the islets of Langerhans Endocrine glands discharge secretions into the blood & lymph
Pathologic state caused by excess production of one or more of the anterior pituitary hormones (gigantism)
Common factor is presence of a pituitary adenoma
Growth hormone and/or prolactin often in excess
Overproduction GH (before puberty) leads to gigantism which is less common than acromegaly (after puberty)
Overproduction of prolactin causes prolactemia
hyperpituitarism
acromegaly
Bone thickening with transverse growth & tissue enlargement
Face & hands most affected
Visual defects r/t pressure from pituitary tumor on optic nerve, soft tissue swelling, or hypertrophy of face
Cartilage overgrowth
Organs can enlarge
Treatment r/t cause (hyperplasia or tumor)
Irradiation of Pituitary Gland
Surgical removal of tumor (transfrontal or transsphenoid approach)
Excessive output of dilute urine
Antidiuretic hormone deficiency or inability of kidneys to respond to ADH results in the excretion of large volumes of very dilute urine
Diabetes insibitus
s/s diabetes insibitus
Massive diuresis, dehydration, and thirst
Malaise, lethargy, and irritability
Production of excess amounts of corticosteroids, particularly glucocorticoid
Overproduction: endogenous (internal) as well as exogenous (external)
cushings disease
s/s of cushings disease
Truncal obesity
Protein wasting
Facial fullness, often called a “moon face”
Purple striae on the abdomen, breasts, buttocks, or thighs
Osteoporosis
Hypokalemia of uncertain etiology
Produces marked changes in personal appearance, including obesity, facial redness, hirsutism (growth of hair), menstrual disorders, hypertension of varying degrees, muscle wasting of extremities
Additionally delayed wound healing, insomnia, irrational behavior, and mood disturbances such as irritability and anxiety
