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ME 528- Patient Communication > Lifestyle Improvements > Flashcards

Lifestyle Improvements Flashcards

1
Q

Steps for readiness for change

A

Pre-contemplation
Contemplation
Preparation
Action
Maintenance

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2
Q

Readiness for change can be _________

A

bidirectional

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3
Q

A patient may be ______ to change but that may not be ________ to change

A

ready, motivated

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4
Q

What is the key for readiness to change with patients?

A

Discovering what will move them from readiness to action

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5
Q

Motivational Interviewing Approach

A

DARN CAT

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6
Q

What is D in DARN CAT

A

Desire to change

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7
Q

What is A in DARN CAT

A

Ability to change

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8
Q

What is R in DARN CAT

A

Reasons to change

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9
Q

What is N in DARN CAT

A

Need to change

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10
Q

What is C in DARN CAT

A

Commitment to change

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11
Q

What is second A in DARN CAT

A

Action, intention to act

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12
Q

What is T in DARN CAT

A

Taking steps to change

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13
Q

What are the two phases in readiness to change?

A

Preparing for change and mobilizing for change

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14
Q

What is involved in preparing for change?

A

Desire to change
Ability to change
Readiness to change
Need to change

DARN

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15
Q

What is involved in mobilizing for change

A

Commitment to change
Action, intention to act
Taking steps to change

CAT

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16
Q

What is OARS?

A

Open ended questions
Affirmations
Reflective listening
Summaries

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17
Q

What is O in OARS?

A

Open ended questions

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18
Q

What do open ended questions do in OARS

A

Require patient to start the process of self-examination

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19
Q

What is A in OARS?

A

Affirmations

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20
Q

What do affirmations do in OARS?

A

express acceptance, affirm strengths, express optimism

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21
Q

What is the R in OARS?

A

Reflective listening

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22
Q

What does reflective listening do in OARS?

A

paraphrase what patient says to show you are listening

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23
Q

What is the S in OARS?

A

Summaries

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24
Q

What do summaries do in OARS?

A

combine all the information for clarification with focus on content and feelings

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25
Q

______, ______, ________ approach

A

ask, tell, ask approach

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26
Q

Motivational interviewing is a _______ approach between the patient and provider

A

collaborative

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27
Q

MI helps: recognize the ______ of the patient

A

expertise

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28
Q

MI helps: elicit or draw from patients rather than ______ on them

A

imposing

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29
Q

MI helps: express _________

A

empathy

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30
Q

MI helps: _______ the problem from the patient’s perspective

A

understand

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31
Q

MI helps: direct the conversation towards topics that are likely to increase the patients _______ ______ _______

A

readiness for change

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32
Q

Cigarette smoke contains ________ chemicals, _____ are known to cause cancer

A

7000, 69

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33
Q

Smoking is responsible for ______ or lung cancer deaths and _____ of deaths caused by COPD

A

90%, 80%

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34
Q

Smoking is linked to ________ and ______ ______

A

emphysema, chronic bronchitis

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35
Q

78% of adults smoked their first cigarette by ____

A

18 years old

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36
Q

Smoking harms nearly every _____ in the body

A

organ

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37
Q

Why do we care if patients smoke?

A

cancer, cardiovascular disease, COPD, slows HPV clearing, decrease sperm count, increase erectile dysfunction, dental disease, slowed wound healing, suppressed immune system

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38
Q

which gender smokes more?

A

Men

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39
Q

Prevalence of smoking is highest in

A

American Indians/Alaska natives

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40
Q

Lowest prevalence of smoking in the US is

A

Asian-Americans

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41
Q

7.6% of ____ ______ students current cigarette smokers

A

high school

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42
Q

2.1% ______ _____ students current cigarette smokers

A

middle school

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43
Q

Second hand smoke is a _________ cause of stroke

A

definitive

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44
Q

There is no risk-free level of exposure to ______ ______

A

secondhand smoke

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45
Q

Brief exposure to secondhand smoke can trigger a ______ ______

A

heart attack

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46
Q

Secondhand smoke is especially harmful to _____ ______

A

young children

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47
Q

Secondhand smoke is linked to ____ _____ _____ _____

A

Sudden Infant Death Syndrome

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48
Q

Patients with non-small cell lung cancer who are exposed to secondhand smoke have _____ outcomes

A

worse

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49
Q

Lung cancer patients who are exposed to secondhand smoke are ________ likely to die than patients not exposed

A

more

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50
Q

Menthol smokers are _____ ______ than non-menthol smokers to _______

A

less likely, quit

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51
Q

Menthol cigarettes increase both _____ and ______ of addiction

A

likelihood and degree

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52
Q

The minty taste of menthol can mask the ___ _____ ______ of smoking-induced _____ _____

A

early warning signs, respiratory problems

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53
Q

Menthol cigarette use is more prevalent in _________ community

A

prevalent at 50%

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54
Q

Menthol use in heterosexuals

A

38%

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55
Q

What does ENDS mean?

A

Electronic Nicotine Delivery System

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56
Q

What are the most commonly used tobacco products in children?

A

ENDS/electronic nicotine delivery system

57
Q

Two primary ingredients in ENDS

A

propylene glycol (antifreeze) and vegetable glycerin

58
Q

If a youth uses ENDS does it increase the risk of using traditional cigarettes?

A

substantial evidence

59
Q

What causes addiction in cigarettes?

A

Nicotine

60
Q

Quitting for good requires _______ ______

A

multiple attempts

61
Q

How often do you mention smoking cessation?

A

personal preference, some say even visit

62
Q

What are opportunities to talk about quitting?

A

persistent health concerns related to smoking, new motivation (baby), financial concern

63
Q

Example of motivators for quitting

A

money jar, redirect, hypnosis, medications

64
Q

Wellbutrin (bupropion) for smoking is

A

Zyban

65
Q

Chantix is a

A

nicotine receptor binder

66
Q

NRT means

A

Nicotine replacement therapy

67
Q

Most effective NRT

A

patch + gum

68
Q

What do you need to educate patients on with NRT?

A

Overdose

69
Q

Benefits of NRT

A

easy to control levels of nicotine, easy to adjust, cheap

70
Q

Benefits of the nicotine patch

A

easy, once a day, few side effects, constant levels

71
Q

Side effects of nicotine patch

A

skin irritation, less flexible dosing, slow onset

72
Q

Benefits of nicotine lozenge

A

easy, higher delivery than gum

73
Q

Side effects of nicotine lozenge

A

no food/drink 15 minutes before/during, nausea, no chewing or swallowing

74
Q

Which NRT are OTC?

A

gum, patches, lozenges

75
Q

which NRT are prescription?

A

spray and inhaler

76
Q

Benefits of nicotine gum

A

flexible dosing, fast delivery

77
Q

Side effects of nicotine gum

A

do not use with dental issues, no food/drink 15 minutes before or during, need to use frequently

78
Q

Benefits of nicotine nasal spray

A

flexible dosing, fast delivery

79
Q

Side effects of nicotine nasal spray

A

nose/eye irritation common (disappears in a week), frequent use in day

80
Q

Benefits of nicotine inhaler

A

flexible dosing, mimics hand to mouth, few side effects

81
Q

side effects of nicotine inhaler

A

request use in the day, mouth/throat irritation

82
Q

Benefits of Wellbutrin

A

easy, pill, few side effects, can be used with NRT

83
Q

side effects of Wellbutrin

A

contraindicated with some meds or disease

84
Q

benefits of chantix

A

easy, pill, no drug interactions

85
Q

side effects of chantix

A

people need to actually take it consistently for 3 months, nightmares, mood change, nausea

86
Q

benefits of nortriptyline

A

TCA antidepressant, cheap, pill, can use with NRT

87
Q

side effects of nortriptyline

A

high side effect profile because TCA

88
Q

What therapy is most effective for quitting smoking

A

combination therapy

89
Q

Contraindications for NRT

A

severe HTN, PVD, pregnancy, lactation, under 18, MI within the last month, arrhythmia, angina, active hyperthyroid, active PUD

90
Q

It takes most people ____ times to quit

A

3

91
Q

What else should people have in addition to medication for quitting?

A

behavioral therapy

92
Q

What is an important consideration for quitting smoking?

A

Picking the right time, do not quit during major life stressors

93
Q

What is the countdown to quit?

A

set a date 1-2 weeks in the future

94
Q

Why do people fain weight when they quit smoking?

A

food tastes better, comfort effect with the movement of hand to mouth, metabolic changes (smoking increases your metabolism)

95
Q

What is BMI

A

Body mass index

96
Q

Normal BMI

A

18.5- 24.9

97
Q

What # is obese on BMI

A

30

98
Q

wait circumference predisposition metabolic concerns

A

women >35 inches
men >40 inches

99
Q

Obesity increases risk for

A

HTN, hyperlipidemia, LDL, diabetes

100
Q

Weight management

A

Diet, exercise, weight loss, support groups, counseling, surgery, medications

101
Q

Medications for obesity are best used

A

as an adjunct with changes in diet choices and exercise program

102
Q

RX drugs approved for long term use (12 months)

A

bupropion-naltrexone (Contrave), liraglutide (Saxenda), Orlistat (Xenical/Alli), pentermine-topiramate (Qsymia)

103
Q

Healthy diet highlights

A

limit saturated & trans fats, sodium, added sugars

104
Q

Realistic expectations for weight loss

A

1-2lbs per week may be better long term goal

105
Q

For a weightless for 1-1.5lbs per week, daily intake should be reduced by _________ calories/day

A

500-750 calories per day

106
Q

General diet/nutrition suggestions

A

eat low in the food chain (fruits, vegetables)
Portion and stimulus control
Beware of fluids (soda/beer/wine/etc.)
Exercise

107
Q

Excess sodium clinically significant role in

A

hypertension

108
Q

Lowering sodium intake in some populations is effective in BP management

A

elderly, Black, medication resistant HTN

109
Q

Recommended sodium intake

A

2,300 mg/day US dietary guidelines
1,500mg/day American Heart Association

110
Q

Where is most sodium intake from?

A

packaged foods and restaurants

111
Q

Caffeine is the worlds most widely consumed

A

psychoactive drug

112
Q

What is the safe/moderate dose for caffeine

A

400mg/day

113
Q

What is the most caffeinated drink?

A

Tea
light tea- the first thing that comes out is caffeine

114
Q

The darker the color the tea the less _____ it is

A

caffeinated

115
Q

Caffeine and pregnancy if moderate ________ is not a major contributor to miscarriage or preterm birth

A

<200mg

116
Q

Caffeine with kids is more closely tied to

A

sugary drinks/energy drinks

117
Q

Kids are more at risk for what when drinking Mountain Dew

A

caffeine intoxication

118
Q

Sedentary lifestyle is related to

A

mental health issues, increased risk of diabetes, increase in weight/obesity, increase in heart disease, lethargy, increased risk of hypertension

119
Q

Sedentary lifestyle is also known as

A

sitting disease

120
Q

Exercise general considerations: type

A

ortho/medical concerns, personal preference, availability of exercise facilities, locations

121
Q

Exercise goal considerations: intensity

A

target HR= 70-80% of maximum HR

122
Q

Maximum HR calculation

A

220-age

123
Q

Exercise goal considerations: duration

A

20-60 minutes, gradual buildup

124
Q

Exercise goal considerations: frequency

A

3-5 times per week

125
Q

A program of regular exercise that includes cardiopulmonary resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults.

A

American College of sports Medicine definition of exercise

126
Q

ASCM moderate intensity recommendations

A

cardiopulmonary exercise training
30> minutes/day for 5> days a week for 150 minutes/week

127
Q

ASCM vigorous intensity recommendations

A

cardiorespiratory exercise training
20> min/day for 3>days/week for 75minutes/week

128
Q

ASCM moderate intensity Heart rate goals

A

50-70% of maximum HR

129
Q

ASCM vigorous intensity heart rate goals

A

70-85% of maximum HR

130
Q

Benefits of exercise

A

lower heart rate and blood pressure, improvement aerobic capacity, improved strength and endurance

131
Q

Ratings of perceived exertion on a scale of 1-10 moderate intensity

A

moderate-intensity aerobic activity is a 5-6 on a scale of 1-10

132
Q

Ratings of perceived exertion on a scale of 1-10 vigorous intensity

A

vigorous intensity aerobic activity is a 7-8 on a scale of 1-10

133
Q

Adults should also perform ____ _______ for each of the major ____ _____

A

resistance exercises, muscle groups

134
Q

Adults should perform ______ ______ involving balance, agility and coordination

A

neuromotor exercise

135
Q

Maintaining joint ROM, complete _____ ________ for each major muscle-tendon group

A

flexibility exercises

136
Q

Adults who are unable to meet exercise targets can still benefit by

A

engaging in amounts of exercise less than recommended

137
Q

You should promote what in all patients

A

smoking cessation, healthy eating and physical activity

138
Q

It is important to promote _____ _____

A

realistic expectations

ME 528- Patient Communication (5 decks)

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