N389 Unit 2

Question 1

Strategies for interacting and low vision clients

Answer 1

• 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.

Question 2

Exercise recommendations for pregnant women

Answer 2

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

Flexibility and balance exercises are valuable

Question 3

Principles of nutrition when caring for a pregnant woman

Answer 3

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

Question 4

Trends in substance abuse among adults

Answer 4

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

Question 5

Trends in substance abuse among adolescents

Answer 5

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

Question 6

Alcohol use in teens

Answer 6

Higher among white teens than Hispanic, black or Asian teens

White females were the highest (drinking more than males)

Question 7

Epidemiology of occupational safety and health concerns among health care workers

Answer 7

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

one of highest rates of work-related injuries and illnesses

Question 8

Common workplace injuries

Answer 8

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

Question 9

Types of violence

Answer 9

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

Question 10

Occupational stress

Answer 10

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

Question 11

Occupational Safety and Health Administration

Answer 11

• 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

Question 12

National Institute for Occupational Safety and Health

Answer 12

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

Question 13

Professional Organizations

Answer 13

• American Nurses Association
• ASIS
• Emergency Nurses Association

Question 14

Joint Commission

Answer 14

Accrediting body

Question 15

Legislation

Answer 15

No federal safe patient handling laws

Some state-level

Question 16

Safe Patient Handling and Mobility

Answer 16

Duke Moves- move often, very early, and safely

Promote consistent use of lifting devices

Question 17

No federal standard requiring workplace violence protections

Answer 17

Some state level approaches

OSHA voluntary guidelines

Question 18

Stress prevention

Answer 18

Organizational change program

Counseling

Training in stress management

Question 19

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

Answer 19

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

Question 20

First steps in reducing workplace violence

Answer 20

Management needs to be committed and employees need to participate

Question 21

Purpose of NIOSH

Answer 21

Conduct and fund research

Make recommendations

Provide training

*not a regulatory body

Question 22

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

Answer 22

Hazards need to be designed out and substituted with safer processes

Question 23

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

Answer 23

Can result in substandard care

Poor health outcomes

Health disparities

Question 24

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

Answer 24

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

Question 25

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

Answer 25

- Genetics and biology - Sociocultural influences - Environment - Individual behavior

Question 26

Genetics and biology on obesity

Answer 26

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

Question 27

Sociocultural influences

Answer 27

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

Question 28

Environment

Answer 28

What food is available, restaurants, supermarkets, access to food physically and financially Is physical activity safe and a possibility

Question 29

Individual behavior

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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

Question 32

Discuss the health consequences of obesity

Answer 32

negatively affects every system of the body

Question 33

Quality of life consequences of obesity

Answer 33

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

Question 34

Impact of obesity and targeted interventions on children and adolescents

Answer 34

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

Question 35

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

Answer 35

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

Question 36

Impact of obesity and targeted interventions on adults

Answer 36

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

Question 37

Impact of obesity and targeted interventions on older adults

Answer 37

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)

Question 38

Pregnancy and Obesity

Answer 38

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

Question 39

Losing muscle and gaining weight

Answer 39

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**

Question 40

Losing weight in older adults

Answer 40

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

Question 41

Tips for working with obese

Answer 41

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

Question 42

How do we diagnose obesity

Answer 42

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

Question 43

Frequent comorbid conditions associated with obesity

Answer 43

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

Question 44

Strategies to improve weight-related bias and discrimination

Answer 44

- 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

Question 45

Latinos and substance abuse treatment

Answer 45

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).

Question 46

African American and substance abuse treatment

Answer 46

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.

Question 47

Highest rate of substance abuse?

Answer 47

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

Question 48

First step in reducing workplace violence

Answer 48

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.