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Sprinig 2018 > N389 Unit 2 > Flashcards

N389 Unit 2 Flashcards

1
Q

Strategies for interacting and low vision clients

A
  • Interact with the person not their disability
  • Introduce yourself by name and make eye contact when speaking
  • Speak in usual conversational voice
  • Address the person by name when talking in a group
  • Identify yourself
  • Indicate the end of a conversation
  • Offer your arm, don’t grab theirs
  • Don’t interfere with their belongings
  • Use verbal directional cues around room, hallway, etc.
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2
Q

Exercise recommendations for pregnant women

A

Moderate exercise greater than or equal to 30 minutes per day, most days of the week;

Flexibility and balance exercises are valuable

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3
Q

Principles of nutrition when caring for a pregnant woman

A

Need folic acid, calcium, fatty acids, iron, vitamin D, iodine, supplements and vitamins

Limit caffeine

Avoid uncooked meats, unpasteurized milk, fish that contains mercury, deli meat, excessive caffeine, smoked fish, raw shellfish, raw eggs, soft cheese, pate, unwashed vegetables

Emphasize weight loss if necessary before pregnancy not during

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4
Q

Trends in substance abuse among adults

A

Blacks have lower rates of substance abuse but higher rates of alcohol dependence than whites

Minorities are perceived as having higher rates of drug addiction so are often prescribed less pain medication due to bias among health care workers

Consider opioid crisis versus crack crisis

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5
Q

Trends in substance abuse among adolescents

A

44% of HS use marijuana

Over 50% HS use alcohol

14% HS using cigarettes, steady decline, more are using e-cigs

Higher % of abuse of OTC than illicit drugs

Black teens marijuana use higher than Hispanic or whites; males more than females

White teens more likely to abuse Rx drugs; females more than males

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6
Q

Alcohol use in teens

A

Higher among white teens than Hispanic, black or Asian teens

White females were the highest (drinking more than males)

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7
Q

Epidemiology of occupational safety and health concerns among health care workers

A

More workers are injured in healthcare social social assistance industry sectors than any other

one of highest rates of work-related injuries and illnesses

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8
Q

Common workplace injuries

A

Overexertion and bodily reaction (manually lifting, moving, and repositioning patients), slips, trips and falls, contact with objects, violence, exposure to harmful substances, transportation incidents, others

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9
Q

Types of violence

A

Type 1- criminal intent

Type 2- perpetrator is customer receiving services from the company

Type 3- perpetrator is employed by the establishment

Type 4- perpetrator has a personal relationship with an employee

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10
Q

Occupational stress

A

harmful physical and emotional responses that occur when the requirements of the job don’t match capabilities, needs or resources of the worker

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11
Q

Occupational Safety and Health Administration

A
  • Regulatory agency
  • Protects from hazards
  • Establishes and enforces protective standards
  • Consultations and assistance
  • Inspection

No standard specific to MC disorder hazards, workplace violence, occupational stress but citations may be issued under general duty clause

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12
Q

National Institute for Occupational Safety and Health

A
  • No regulatory authority
  • Conduct and fund research
  • Recommendations to prevent workplace injury
  • Provide training
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13
Q

Professional Organizations

A
  • American Nurses Association
  • ASIS
  • Emergency Nurses Association
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14
Q

Joint Commission

A

Accrediting body

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15
Q

Legislation

A

No federal safe patient handling laws

Some state-level

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16
Q

Safe Patient Handling and Mobility

A

Duke Moves- move often, very early, and safely

Promote consistent use of lifting devices

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17
Q

No federal standard requiring workplace violence protections

A

Some state level approaches

OSHA voluntary guidelines

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18
Q

Stress prevention

A

Organizational change program

Counseling

Training in stress management

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19
Q

Factors influencing the effectiveness of approaches designed to promote occupational safety and health among healthcare workers

A

Greater impact when hazards are designed out and substituted with safer processes instead of putting emphasis on individual’s to change their behavior

Management needs to be committed and employees need to participate

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20
Q

First steps in reducing workplace violence

A

Management needs to be committed and employees need to participate

21
Q

Purpose of NIOSH

A

Conduct and fund research

Make recommendations

Provide training

*not a regulatory body

22
Q

What is one strategy that would make the largest impact on workplace safety for nurses?

A

Hazards need to be designed out and substituted with safer processes

23
Q

How can unconscious bias impact the care given to a patient?

A

Can result in substandard care

Poor health outcomes

Health disparities

24
Q

Why has obesity bias increased and its impact on quality of healthcare?

A

Increasing levels of obese people and obese people needing treatment

Decreases quality of care:

  • Feel discriminated against and don’t want to seek care
  • Providers don’t understand underlying issue
25
Q

Contributing factors of obesity including genetics, biology, sociocultural influences, the environment, and individual behavior

A
  • Genetics and biology
  • Sociocultural influences
  • Environment
  • Individual behavior
26
Q

Genetics and biology on obesity

A

Genetic component to acquiring excess weight is complex

Genetic susceptibility towards overweight/obesity seems to be fully expressed in environments in which food is tasty, variable, plentiful, cheap and widely promoted, and in which technology has replaced human physical labor

In most cases, obesity is a polygenic disease in which numerous genes interact to facilitate overweight/obesity when the environment is permissive

27
Q

Sociocultural influences

A 
Types of foods
Food preparations practices
Eating habits (rushed vs slow)
Access to food
Socioeconomic status
28
Q

Environment

A

What food is available, restaurants, supermarkets, access to food physically and financially

Is physical activity safe and a possibility

29
Q

Individual behavior

A

Increased portion sizes, poor food choices, lack of access to healthy foods, decreased psychical activity

30
Q

How to optimize sensitivity to the needs and concerns of the patient

A 
Don't be judgmental
Don't make assumptions
Consider all influences and underlying factors
Use motivational interviewing
Treat with respect and sensitivity
31
Q

Describe trends in the prevalence of obesity over the past 30 years

A

Increasing worldwide; 30% of world population is overweight/obese

Increasing in US across all states; 2/3 of Americans are overweight/obese- continued to grow

2.1 billion people are overweight/obese worldwide

32
Q

Discuss the health consequences of obesity

A

negatively affects every system of the body

33
Q

Quality of life consequences of obesity

A

Diminishes quality of life in some cases due to illness, lack of mobility, missed work, stigma

Income, social status, employment and working conditions, biology and genetics, culture, social support, health services, social environment, personal health practices, child development, living conditions, safe neighborhood

34
Q

Impact of obesity and targeted interventions on children and adolescents

A

Concerned with reducing stigma and discrimination, changing the environment in schools, limiting sugar sweetened beverages, monitoring growth charts, limiting added sugars and salts early in life, limiting screen time

Want to encourage breast feeding and healthy diet for whole family

Want them in 5-85% ile

35
Q

Impact of obesity and targeted interventions on fertility, prenatal, intra-partum, post-partum

A

Fertility- PCOS (polycystic ovary syndrome), lack of regular menstruation, decreased levels of pregnancy both planned and spontaneous

Prenatal- UTI, high blood pressure, miscarriage, preterm labor

Intra-partum- complications, dysfunctional labor, bleeding, blood clots, wound infections, more C sections, prolonged delivery

Postpartum- increased hospital time, infection/bleeding, breastfeeding difficulty

Want to encourage weight loss prior to pregnancy
Monitor and screen for diabetes
Limit gestational weight gain
Monitor for preclampsia

36
Q

Impact of obesity and targeted interventions on adults

A

Follow healthy eating plan, focus on portion sizes, be physically active, reduce screen time, keep track of weight and BMI

37
Q

Impact of obesity and targeted interventions on older adults

A

Do not ignore the benefits to older adults!

Obesity contributes toward negative health consequences and functional decline (more challenges with physical activity/safety):

Because of weight and body habitus and age, anticipate difficulty getting up, getting down, and encourage all types of ambulatory activity

Use machines that are both safe and structural secure (i.e., frames/seats)

If OA/joint pain, alternate lower-impact activities

Recommendation: Improve availability of fruits, veggies and whole grains at convenience stores (areas without supermarkets)

38
Q

Pregnancy and Obesity

A

Comprehensive approach across care

Encouraging weight loss prior to attempting to conceive

Restricted gestational weight gain

Modifications to routine prenatal care, examples:
First trimester screening for diabetes
Close monitoring of blood pressure and baseline labs for preeclampsia
Early ultrasound
Anesthesia consultation
Ensure provision of resources for delivery
Obesity alone is not an indicator of early delivery

39
Q

Losing muscle and gaining weight

A

Non-exercising adults lose over 5 pounds of muscle and add about 15 pounds of fat each decade, bringing about an increase in body fat that may be 50% greater than the increase in bodyweight

Older adults

40
Q

Losing weight in older adults

A

Studies suggest that intentional, structured weight loss is beneficial
Focus on weight-loss risks that may be exacerbate the normal aging process

Nutrient absorption – post-menopause estrogen reduction can affect calcium absorption (i.e., calcium and other nutritional supplements)

Bone density loss – provide nutritional supplements (i.e., Vitamin D supplements)

Lean muscle mass loss – muscle strengthening exercises, adequate protein intake

41
Q

Tips for working with obese

A

Describe priorities of nursing workforce caring for patients who are obese

create inclusive environment

Have necessary equipment to accommodate obese people (chairs, bp cuffs, lifts, tables,etc.)

Recognize there is more to obesity than food and inactivity

Focus on underlying causes

Recognize that weight loss is difficult and they probably have tried many times before

Use motivational interviewing

Understand that people respond more favorably to positive themes than stigmatizing ones

42
Q

How do we diagnose obesity

A

BMI

25-29.9 - overweight
30-34.9 - obesity 1
35-39.9 - obesity 2
40 < or greater is obesity 3

43
Q

Frequent comorbid conditions associated with obesity

A

Cardiovascular disease, stroke, high bp, diabetes, cancer, osteoarthritis, pancreatitis, fatty liver disease, PCOS, impaired kidney function, depression, and many others

44
Q

Strategies to improve weight-related bias and discrimination

A
  • Treat patients with same care and courtesy you treat all
  • Look at physical environment of the healthcare setting
  • Identify personal attitudes
  • Understand complexity of obesity
  • Don’t make assumptions
  • Consider previous negative interactions with providers
  • Understand they may have tried to lose weight previously and were unsuccessful
  • Recognize that small weight loss can have large impacts
  • Acknowledge the difficulty of weight loss
45
Q

Latinos and substance abuse treatment

A

Latinos have the lowest rates, even though they are also more like to go to jail than White (not more than Blacks) because of substance abuse issues.

Latinos have traditionally the lowest access to substance abuse and mental health treatment (also medical treatment in general).

46
Q

African American and substance abuse treatment

A

The higher rates of substance abuse treatment among Blacks are largely due to court mandated treatment which is dictated by criminal justice responses. Since Blacks are more likely to go to jail for substance abuse than Whites, they are more likely to seek treatment (they have to), despite the multiple barriers they would encounter if they would seek voluntary substance abuse treatment.

47
Q

Highest rate of substance abuse?

A

African American’s have a higher rate of treatment in substance use than Non-Latino Whites and Latinos and/or minorities have higher rates of treatment

48
Q

First step in reducing workplace violence

A

The first step is assessment (as in the nursing process). You first need to find out what is the incidence and prevalence of work place violence and what types are being experienced. For example, is the violence perpetrated by patient vs employees vs an intimate partner? The type of violence would help inform what type of programs and policies to implement.

Sprinig 2018 (6 decks)

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