217 Large Group - After Midterm to Final Study Cards Flashcards
1
Q
What are some advantages of self-monitoring blood pressure at home?
A
o Elevated blood pressure may be detected in people previously unaware of a problem.
o Able to provide information regarding the pattern of blood pressure values.
o May benefit from actively participating and may promote enhanced adherence to treatment.
o Helps to confirm elevated blood pressure readings related to white coat hypertension.
2
Q
_______ is commonly defined as a physiological process that provides an individual with protection or defense from disease.
A
Immunity
3
Q
Which is the most common “problem” affecting a person living with Multiple Sclerosis?
A
Fatigue
4
Q
Multiple sclerosis is an immune-mediated, progressive _________ disease of the CNS.
A
demyelinating
5
Q
True or false: MS affects men more frequently than women.
A
False
6
Q
List the four types of MS.
A
- relapsing-remitting
- primary progressive
- secondary progressive
- progressive relapsing
7
Q
True or false. Multiple Sclerosis signs and symptoms are clear and the diagnosis is quick and simple
A
False
8
Q
The thyroid gland is a butterfly-shaped organ located in the lower neck, ________ to the trachea.
A
Anterior
9
Q
The thyroid hormones, through their widespread effects on cellular _________, influence every major organ system.
A
metabolism
10
Q
List the five overarching functions of hormonal regulation.
A
- Fetal differentiation of the reproductive and central nervous system
- Sequential growth and development during childhood and adolescence
- Reproduction
- Metabolic activity
- Adaptive responses
11
Q
Define advance care planning per CNA.
A
An ongoing process of reflection, communication and documentation regarding a person’s values and wishes for future health and personal care in the event they become incapable of consenting to or refusing treatment or other care. Conversations to inform health-care providers, family and friends — and especially a substitute decision-maker — are regularly reviewed and updated. Such conversations often clarify their wishes for future care and options for their end of life. Attention must also be paid to provincial/territorial legal and health guidelines.
12
Q
List four considerations regarding the nurse and professional boundaries.
A
- establishing therapeutic relationships with their clients: trust, respect, empathy, power
- maintaining healthy professional boundaries, not the client
- establishing therapeutic relationships with their clients: trust, respect, empathy, power
- maintaining healthy professional boundaries, not the client
13
Q
What happens with partial guardianship?
A
“With a partial guardianship, the incompetent person continues to make limited decisions; with a full guardian-ship, the person loses all of his or her rights to make decisions. “
14
Q
What is trusteeship?
A
When an older adult no longer has the capacity to make decisions on financial matters.
15
Q
What is advance care planning?
A
Advance care planning is a way to help you plan and document your wishes for the type of healthcare you wish to receive now and in the future. It is for every adult, especially for people with health issues. It is best done when you’re healthy, before there’s actually an urgent need for a plan.
16
Q
What does the advanced care planning process help you to do?
A
- think about values and wishes for medical treatments you may or may not want
- talk about your healthcare goals
- make a plan that reflects your values and wishes
- document your plan
17
Q
What does a personal directive constitute in Alberta?
A
In Alberta, a personal directive (sometimes called a “PD”) is the legal document that allows you to choose who your decision-maker will be and may provide guidance about your wishes. • Your personal directive only comes into effect if or when the time comes that you are unable to make decisions about your healthcare.
18
Q
In Alberta, do you need a lawyer to create a personal directive?
A
No
19
Q
What is a goals of care designation order?
A
A medical order that describes the general focus of your care. • Helps the healthcare team match your unique values and preferences to care that is most appropriate for you and your healthcare condition. • Written by a doctor or nurse practitioner. • Ideally created after conversation between you and members of the healthcare team. • Recognized in all care settings in Alberta. • Changes as your health changes; any doctor can update your GCD order.
20
Q
Means using any appropriate medical and surgical treatments, including going to the hospital, to try to “fix the fixables” with a focus to live as long as possible and maintain your desired quality of life. The team will not use pushing on the chest (“CPR”), a breathing machine (“ventilator”) or intensive care unit (“ICU”). “XX” communicates that there are limits to what resuscitation and life support can achieve for you.
A
M1
21
Q
“XX” means you will be treated at home or a care facility and avoid hospital admission. Medical treatments available in the home or a care facility will be used to try to “fix the fixables”. If you don’t respond to home-based treatments, your healthcare team will talk to you about re-evaluating your wishes and goals, which may include changing your focus of care to comfort care
A
M2
22
Q
“XX” means that the focus of care is to provide comfort, with symptom control and using medical treatments that maximize your quality of life rather than focusing on your length of life.
A
C1
23
Q
“XX” means that you are in the final hours or days of life and all treatments are focused on your comfort and support of those close to you.
A
C2
24
Q
“XX” means that any appropriate medical and surgical treatments including pushing on the chest (“CPR”) a breathing machine (“ventilator”) and intensive care unit (“ICU”) will be used to try to prolong your life during a critical illness.
A
R1
25
“XX” means that any appropriate medical and surgical treatments including a stay in the intensive care unit care and breathing machine (“ventilator”) will be used to try to prolong your life during critical illness. The team will not use pushing on the chest, referred to as resuscitation. This means “No CPR.”
R2
26
“XX” means that any appropriate medical and surgical treatments including a stay in the intensive care unit will be used to try to prolong your life. The team will not use pushing on the chest “No CPR” nor use a breathing machine “No ventilator.”
R3
27
What is a Greensleeve?
A Green Sleeve is a plastic pocket that holds your advance care planning forms. Think of it like a medical passport. • There are two ways to get a Green Sleeve: from your healthcare provider or you can order one online. • It is your property. When you are at home, keep your Green Sleeve on or near your fridge. • Healthcare providers in all settings may ask if you have a Green Sleeve. • If you go to the hospital or a healthcare appointment take your Green Sleeve with you. Be sure it comes home with you.
28
What do Goals of Care do within the medical setting?
How health care professionals describe and communicate the general focus of the care for the patient. Gives direction about specific care.
29
Who is a patient's agent?
Someone who has been formally designated to make decisions on their behalf. Only comes into effect when you lack the capacity to make decisions.
30
Does an enduring power of attorney authorize medical or financial decisions to be made on your behalf in the event that you cannot?
Financial
31
What are the responsibilities of the nurse relative to advanced directives?
* Initiate advance directive conversation
* Ensure that decision making abilities are periodically re-evaluated
* Support clients
* promote health & wellbeing
* promote dignity
* be informed about advanced directives
* Advocacy and respecting the client's decision
* Promote communication upon admissions to care
*
32
What are the responsibilities of the nurse relative to advanced directives?
* Initiate advance directive conversation
* Ensure that decision making abilities are periodically re-evaluated
* Support clients
* promote health & wellbeing
* promote dignity
* be informed about advanced directives
* Advocacy and respecting the client's decision
* Promote communication upon admissions to care
*
33
Can student nurses initiate a greensleeve discussion?
Yes
34
What do some boundary warning signs include?
* frequently thinking of the client when away from work;
* frequently planning other client’s care around the client’s needs;
* spending free time with the client;
* sharing personal information or work concerns with the client;
* feeling responsible if the client’s progress is limited;
* favoring one client’s care over another’s;
* sharing secrets with the client;
* selective reporting of client’s behaviour (negative or positive);
* swapping client assignments to provide care to a particular client;
* communicating in a guarded and defensive manner when questioned regarding interactions with the client;
* changing dress style for work when working with the client;
* receiving gifts or continued contact/communication with the client after discharge;
* denying the fact that the client is a client;
* acting and/or feeling possessive about the client; and
* denying that you have crossed the boundary from a therapeutic to nontherapeutic relationship
35
True or False. Both the nurse and the client/patient are responsible for maintaining healthy, professional boundaries
False, The nurse is responsibile.
36
What is decision making and what does it require that someone be able to do?
Decision-making capacity is a measure of a person’s ability to make an informed and logical decision about a particular aspect of his or her health care.
Decision-making capacity requires that the person be able to do all the following:
* Understand and process information that is relevant to the decisions about diagnosis, prognosis and treatment options
* Weigh the relative risks, benefits and outcomes of decisions in relation to one’s own situation
* Apply personal values to the situation
* Arrive at a decision that is consistent over time
* Communicate the decision to others
37
When is someone assumed to have mental capacity?
An individual is assumed to have capacity unless there is evidence to the contrary. It is generally described as the ability to understand the information needed to make a decision and to appreciate the consequences of that decision.
38
Should decision-making capacity in older persons be based on chronological age or a particular diagnosis.
No
39
What are some advantages and disadvantages of self-monitoring blood pressure at home (P & P)?
Advantages
* Elevated blood pressure may be detected in people previously unaware of a problem.
* Able to provide information regarding the pattern of blood pressure values.
* May benefit from actively participating and may promote enhanced adherence to treatment.
* Helps to confirm elevated blood pressure readings related to white coat hypertension.
Disadvantages
* Improper use of the device and inaccurate readings.
* May be needlessly alarmed by one reading.
* May become overly conscious of their blood pressure and inappropriately adjust medication intake.
40
What are some benefits related to patient use of technology at home to self-manage care?
* Improved patient outcomes, especially for those with chronic illnesses (heart failure, diabetes)
* Increased quality of care
* Increased patient involvement in the care process.
* Enabling independence for patients wishing to stay at home
* Technology can be used as a tool to monitor symptoms of disease and therefore affords patients the opportunity to manage chronic illness. The need to manage chronic conditions and to actively engage in a lifestyle that fosters health is increasingly recognized as the responsibility of the patient.
* Reduced costs from less hospital utilization
41
What are some precautions related to patient use of technology at home to self-manage care?
* Takes a long time before innovation of promising technology is implemented on a wide scale
* The first striking element of the included studies on patient self-care and self-management is the use of varied and inconsistent terminology: self-care, self-management, self-monitoring, self-regulation, adherence and compliance reveal a confused picture. The terms self-care and self-management are often used interchangeably or simultaneously, sometimes referring to knowledge or awareness, in other cases meaning maintaining health and managing a chronic illness. The need for conceptual clarity is not new
42
What is the definition of the concept of self-adherence?
* The North American Nursing Diagnosis Association International (NANDA-I) defines “adherence behavior” as a “**self-initiated action** taken to promote wellness, recovery, and rehabilitation.”
* Haynes et al. defined adherence as the **extent to which patients follow the instructions** they are given for prescribed treatments.
* Christensen offered an alternative definition in keeping with a less paternalistic approach.
* Adherence in this setting is **patient-focused** and is the **extent to which a person’s actions or behaviors coincide with advice or instruction from a healthcare provider** intended to prevent, monitor, or ameliorate a disorder.
* Cohen defined adherence as “**persistence in the practice** and **maintenance of desired health behaviors** and is the result of active participation and agreement.”
43
What is a key element in a patient's adherence?
The theme underlying the patient’s total or positive adherent behavior suggests that the **patient views or believes the professional to be a trusted and knowledgeable source** concerning recommended treatment for the disease or health state in question.
44
What is the difference between adherence, partial adherence, and non-adherence?
1. Adherence: following agreed upon instructions
2. Partial adherence: somewhat, whether intentionally or unintentionally
3. Non-adherence: not following
45
XX is defined as “self-initiated action taken to promote wellness, recovery, and rehabilitation.”
adherence behaviour
46
What is involved at both ends of the scope of adherence?
Includes patient's intentional or rational decision to stop the medication or change the dose or frequency of the medication. Also included is the patient's unintentional change in medication-taking behaviour, which represents a nonpurposeful overlooking of taking the medication.
47
They mention motivational interviewing in Giddens. In the video *motivating patients to promote adherence*, they referred to providing **empathy** as the heart of motivational interviewing to promote adherence. What does OARS stand for?
Open-ended questions
Affirmations
Reflection statements
Summary statements
48
Within health care, the consequences of non-adherence fall into which three categories?
* patient-related
* health-professional related
* health care system related
49
What are included in patient-related consequences of non-adherence?
* Increased mortality and morbidity
* Conflict
* Attributional uncertainty
* Embarrassment
* Changes in quality of life
50
What are included in health professional-related consequences of non-adherence?
* Ambivalence
* Misinterpretation
* Avoidance
* Decisional conflict
* Lack of empathy
51
What are included in healthcare system related consequences of non-adherence?
* Increased costs for healthcare services
52
What are the attributes of adherence?
* Decisional conflict
* Predictability
* Personal experience
* Power conflict
* Agreement
* Alignment
53
What variable has a significant influence on adherence?
Motivation
54
What are the dimensions of adherence relative to compliance, persistence, concordance, and adherence?
adherence: measure of acceptance
compliance: measure of conformance
Persistence: measure of continuation
Concordance: Measure of mutual agreement
55
Describe the purpose and content of medication reconciliation.
Process of Identifying patient’s med errors
* omissions
* duplications
* dosing errors
* drug interactions during transitions in care
56
What are the steps of a medication reconciliation?
Step 1 – Generate a Best Possible Medication History (BPMH);
Step 2 – Reconcile the BPMH at care transitions; and
Step 3 – Document and communicate the medication information
57
True or false: The patient and/or family are integral components of the medication reconciliation process.
True
58
What two sources are acceptable for the development of a best possible medication history (BPMH)?
(1) of which should include an interview with the patient and/or family (as appropriate). Another source of information may be:
## Footnote
(i) the patient’s own list;
(ii) an electronic patient database (e.g., Netcare Pharmaceutical Information Network [PIN], clinical database);
(iii) the patient’s medication containers (e.g., vials, bottles, bubble packs);
(iv) medication calendars;
(v) the Medication Administration Record (MAR);
(vi) new or existing prescriptions for the patient;
(vii) community pharmacy lists;
(viii) referrals or physician orders;
(ix) discharge/transfer information; or
(x) the Emergency Medical Services (EMS) record;
or b) use the current medication list as the BPMH for those patients transferred from another facility where the patient has had a long stay, e.g., long-term care (at least three [3] months).
59
When are common care transitions when BPMH should be reconcilied?
admission, transfer, and discharge
60
What is included in a Best Possible Medication History?
Best Possible Medication History (BPMH) means a complete and up-to-date list of the patient’s current medications at the time of admission verified using at least two sources of information. The BPMH includes:
* name of the medication (all prescribed, over-the-counter, herbal, vitamin, homeopathic, health remedies and substances for recreational use);
* dosage;
* route of administration;
* frequency of administration; and
* time of last dose (as appropriate)
61
Temp 34 - 36 degrees celsius
mild hypothermia
62
Temp 30 - 34 degrees celsius
moderate hypothermia
63
Temp less than 30 degrees celsius
severe hypothermia
64
True or false: Any member of a patient’s health care team may initiate and undertake a goals of care conversation. However, the most responsible health practitioner is ultimately responsible for ensuring that a clinically indicated Goals of Care Designation order has been discussed, established and documented.
true
65
True or false. A personal directive replaces a Goals of Care Designation order
False
66
True or false: The current Goals of Care Designation order travels with the patient regardless of care or living environment and shall be kept in the Green Sleeve, where available.
True
67
Define advance care planning.
Advance Care Planning means a process which encourages people to reflect and think about their values regarding clinically indicated future health care choices; explore medical information that is relevant to their health concerns; communicate wishes and values to their loved ones, their alternate decision-maker and their health care team; and record those choices.
68
Define capacity.
Capacity means 1) the patient understands the nature, risks, and benefits of the procedure and the consequences of consenting or refusing, and 2) the patient understands that this explanation applies to him/her.
69
Define Goals of Care.
Goals of care means the intended purposes of clinically indicated health care interventions and support as recognized by a patient or alternate decision-maker, health care team, or both.
70
Define Goals of Care designation.
Goals of Care Designation means one of a set of short-hand instructions by which health care providers describe and communicate general care intentions, specific clinically indicated health interventions, transfer decisions, and locations of care for a patient as established after consultation between the most responsible health practitioner and patient or alternate decisionmaker.
71
Define personal directive.
Personal directive means a written document in accordance with the requirements of the Personal Directives Act in which an adult names an agent(s) or provides instruction regarding his/her personal decisions, including the provision, refusal and/or withdrawal of consent to treatments/procedures. A personal directive (or part of) has effect with respect to a personal matter only when the maker lacks capacity with respect to that matter.
72
The nurse-client relationship consists of four components that are always present, regardless of the length of the relationship:
trust, respect, empathy and power
73
What are the guidelines relates to professional boundaries?
* The nurse is accountable for establishing therapeutic relationships with their clients
* The nurse is responsible for maintaining healthy professional boundaries, not the client.
* The nurse is accountable for ensuring ethical nursing care and practice in compliance with the values of the Code of Ethics
* The nurse is responsible for establishing therapeutic relationships for specific client health-care needs and within the boundaries of sound professional judgement and professional expectations
74
Define boundary crossing.
– Brief excursions across boundaries that may be inadvertent, thoughtless or even purposeful, if done to meet a specific therapeutic need. They are separate actions and behaviours that deviate from an established professional boundary.
75
What are some reasons for non-adherence to medications?
Barriers to adherence can include a lack of understanding around the medical diagnosis, the need for treatment, or an inability to obtain medication due to cost, scarcity, or time conflicts. Patients may feel shame or mistrust about the issues that limit their disclosure of whether they take medications as prescribed.
76
Reasons for flue vaccine hesitancy.
lacking cues to action, low perceived utility of vaccination, a negative attitude towards influenza vaccines, and fewer previous influenza vaccinations were most frequently and consistently identified as significant barriers to influenza vaccination.
77
What is the purpose of medication reconciliation?
Medication reconciliation is the process of **identifying a patient’s medication errors**, such as **omissions, duplications, dosing errors or drug interactions during transitions in care**.
78
What are the three steps involved in medication reconciliation?
* The three steps involved in the process follow:
* (1) verification by collecting an accurate list;
* (2) clarification of questions about drugs, dosages, frequency and other pertinent information and
* (3) reconciliation of any discrepancies or concerns by communicating with prescribing practitioners.
79
What are some important nursing interventions for a successful medication reconciliation?
* Determine who administers medications.
* View all the medications.
* Be aware of medications that are commonly implicated in discrepancies (e.g., as-needed medications, medications used prophylactically during hospitalization).
* Address ability to get prescriptions filled.
* Address issues that affect adherence (e.g., administration difficulties).
* Allow the patient to ask questions.
80
* The older person’s ability to acclimatize and respond to heat stress is altered by the following age-related changes:
* Higher threshold for the onset of sweating
* Diminished response when sweating occurs
* Dulled sensation of warm environments
* Renal and cardiovascular changes
* Diminished thirst sensation, which can lead to inadequate fluid intake
81
The following age-related changes, which can affect processes involved with heat loss or production, are likely to interfere with an older person’s ability to respond to cold temperatures:
* Inefficient vasoconstriction
* Decreased cardiac output
* Decreased muscle mass
* Diminished peripheral circulation
* Decreased subcutaneous tissue
* Delayed and diminished shivering
82
What is a fever?
* An elevated temperature, or fever, is the body’s protective response to pathologic conditions, such as cancer, infection, dehydration or connective tissue disease. This protective response is blunted in older adults because of age-related changes involving thermoregulation and the immune system.
83
Is an older persons temperature the same as a younger adults temperature?
* Older adults having an oral tempera-ture range of 36.1°C to 36.3°C. Because older adults normally have a lower body temperature and may have a diminished febrile response to infection, it is especially important to determine the person’s usual temperature, as well as to characterize the usual pattern of diurnal variation. A more reliable indicator of elevated temperature in older adults would be an increase of 1°C above the person’s baseline
84
Describe factors that cause variations in body temperature in the older person.
* Internal conditions that affect thermoregulation include metabolic rate, pathologic processes, muscle activity, peripheral blood flow, amount of subcutaneous fat, central nervous system function, temperature of the blood flowing through the hypothalamus, and effects of med-ications and other bioactive substances.
85
Physiological changes associated with fever.
* Hypothalamus controls temperature
* When hypothalamus becomes heated above set point, body will sweat, vasodilation occurs, blood is redistributed to surface cells.
* With fever, heat loss mechanisms can't keep up with excess heat production.
* Body temp rises above normal.
* Chills, shivers, and feels cold as body temp rises; while new set point is being reached.
* Next, the patient feels warm and dry.
* When set point drops, heat loss responses occur; sweating helps.
86
What is the med rec three step process?
MedRec Three Step Process
* Compile the medication list (BPMH, multiple sources used)
* Reconcile the list to orders
* Document/Communicate differences and rationales
87
What are some challenges to the BPMH / medication reconciliation process?
* Inaccurate or out of date record
* lack of honesty on adherence
* patient doesn't know the meds they are on
* time constraints
* language barrier
* Access to history
* no family around
* discrepancy between medication list and medication orders
* low pharmacological experience
* Nurse unfamiliar with process (we are good on admission, but not on transfer from unit to unit; a little bit better of discharge)
88
Who should be involved in med rec?
* Patient, family
* Nurse, nurse practitioner
* Pharmacist
* Authorized prescriber
* Those who are authorized and have it in their scope of practice
89
What are the timeframes for resolve medication discrepancies:
* Acute Care – 24 hours
* Ambulatory Care – first visit
* Home Care – 2 home visits
* Long-Term Care – 48 hours
* Supportive Living – 1 week
90
What are some additional symptoms of long-term fever?
* rash (especially if quickly worsens)
* severe headache,
* stiff neck and pain when bending head forward
* persistent vomiting
* chest pain
* difficulty breathing, abdominal pain
* pain when urinating
* unusual sensitivity to bright light, mental confusion
* change to level of consciousness
* convulsions or seizures
91
Causes of chronic, persistent fever.
* Viral, bacterial, fungal infection
* Food poisoning
* Heat exhaustion
* Serious sunburn
* Risk of dehydration
* Rheumatoid arthritis, tumor, blood clots
* First sign of DVT is an elevated temperature
* Environment can cause as well (temp, humidity, lack of air movement)
92
What are some non-infection related reasons that body temperature is above set point?
* Hot flashes
* Medications
* Vaccinations
* Thyroid problems
* Blood clots
* Environmental factors
* malignant fever; under anesthetic
93
What are some potential consequences of prolonged fever?
* Fatal
* Cardiovascular collapse
* dehydration
* hypotension
* renal necrosis
* CNS depression
* Cerebral edema
* damage to nervous system
94
What are some modifiable risk factors for atherosclerosis?
* Nicotine use
* Diet
* Hypertension
* Diabetes
* Hyperlipidemia
* Stress
* Sedentary lifestyle
* Elevated C-reactive protein
95
What are some non-modifiable risk factors for atherosclerosis?
* Increasing age
* Female gender
* Familial predisposition/genetics
96
What are some signs and symptoms of peripheral vascular disease?
* Pain
* Numbness
* Tiredness
* Auscultation of arteries
* Appearance of skin (ulcers)
97
Where does PVD most commonly affect?
The legs (but also the arms, stomach and kidneys)
98
Define tissue perfusion.
The volume of blood that flows through target tissues.
99
What percentage of the arterial lumen must be obstructed before intermittent claudication is experienced?
50%
100
What percentage of the cross-sectional area must be obstructed before intermittent claudication is experienced?
75%
101
What type of pain indicates severe degree of arterial insufficiency and a critical state of ischemia?
Rest pain. Persistent pain in the forefoot when the patient is resting; worse at night and may interfere with sleep. Requires the extremity be lowered to improve perfusion in distal tissues.
102
How can the site of arterial disease be located?
It can be deduced from the location of claudication, because pain occurs in muscle groups distal to the diseased vessel.
103
With calf pain, where might the suspected reduced blood flow be?
superficial femoral or popliteal artery
104
Pain in the hip or buttock might be due to reduced blood flow where?
Abdominal aorta or common iliac or hypogastric arteries.
105
What intervention is the first choice for a patient who has a single, short segment of a blood vessel that has uniform occlusion?
transluminal angioplasty
106
Which of the following is an indirect result of arterial atherosclerosis?
a) malnutrition
b) aneurysm
c) ulcerations
d) stenosis of lumen
a) malnutrition
107
What is primary hypertension?
high blood pressure from an unidentified cause; also called essential hypertension
108
What is secondary hypertension?
high BP from an identified cause such as renal disease
109
What are risk factors for hypertension?
* Family Hx
* Advanced age
* Smoking
* Obesity
* Sedentary lifestyle
* Diet is a major factor
* Heavy alcohol consumption
* Gender (men greater than women before age 55; women greater than men after 55)
* Being of African descent
* Immigration-related change in socioeconomic status
* High dietary sodium intake
* Low dietary intake of potassium, calcium, magnesium
* Glucose intolerance
110
What does hypertension increase your risk for?
* Cardiac events (heart failure, myocardial infarction, cardiac hypertrophy)
* Aneurysms
* Strokes
* Chronic kidney disease
* Impaired vision
111
With hypertension, which vessels in particular are targeted and affected?
* Heart
* Kidneys
* Brain
* Eyes
112
What can lead to secondary hypertension?
* primary renal disease
* oral contraceptives
* pharmaceuticals
* Alcohol
* Primary aldosteronism
* Cushing syndrome
* Obstructive sleep apnea
* Coarctation of the aorta
113
What are some things that can make hypertension worse?
* caffeine
* decongestants/nasal spray
* cocaine
* antacids (contain sodium)
* amphetamines'
* cyclosporine
* epinephrine
* atypical antipsychotics
* some antidepressants
* oral contraceptives
* erythropoietin
* NSAIDS
* black licorice
114
What causes of hypertension have been suggested?
* Increased sympathetic nervous system activity related to dysfunction of the autonomic nervous system
* Increased renal reabsorption of sodium, chloride, and water
* Increased activity of the renin-angiotensin-aldosterone system
* Decreased vasodilation of the arterioles related to dysfunction of the vascular endothelium
* Resistance to insulin action
115
What are the stages of hypertension?
* Depends on the stage
* Normal
* Prehypertension (mild)
* Stage 1 (moderate): 130-139/80-89 mm Hg
* Stage 2 (severe): \>140/90 mm Hg
* Hypertensive crisis: 180/120 mm Hg Urgent care required
116
What is the DASH diet?
Dietary Approach to Stop Hypertension. Recommends a diet rich in fruits and vegetables, and low-fat dairy products with a reduced content of saturated and total fat.
117
Serving recommendations under DASH diet.
* Grains and grain products;
* Vegetables:
* Fruits:
* Low-fat or fat-free dairy foods:
* Lean meat, fish, and poultry:
* Nuts, seeds, and dry beans:
* Grains and grain products; 7 or 8
* Vegetables: 4 or 5
* Fruits: 4 or 5
* Low-fat or fat-free dairy foods: 2 or 3
* Lean meat, fish, and poultry: \< 2
* Nuts, seeds, and dry beans: 4 or 5 weekly
118
When is hypertension considered drug resistant hypertension?
When it is not controlled by three medications, including a diuretic
119
What produces blood pressure?
cardiac output x systemic peripheral resistance
120
What is a key assessment aspect of hypertension?
Rate, rhythm and character of apical and peripheral pulses!
121
What are some general goals of hypertension care planning?
* Understanding the disease process and its treatment
* Participation in a self-care program
* Absence of complications
* Increasing knowledge
* Consultation and collaboration
* Follow-up care
* Emphasize control rather than cure
* Reinforce and support lifestyle changes
* Reinforce a lifelong process
122
What is systolic dysfunction?
refers to **impaired ventricular contraction**
123
What is diastolic dysfunction?
124
How do cells die in an ischemic stroke?
* Swelling
* Calcium build up
* Oxygen free radicals
125
What causes an ischemic stroke?
* Thrombosis (clot that adheres to a vessel wall called a thrombus)
* Embolism (an intravascular clot that floats in the blood is an emboli and is a detached thrombus)
* Cardiac
* Possible cardiac/aortic emboli
* Arterial
* Cryptogenic
* Lacunar infarct
* Hypoperfusion
* Inflammation of vessel wall
* Dissection of arterial wall
126
What important legislation relates to protection of privacy?
* Health Information Act (HIA)
* Alberta Freedom of Information and Protections of Privacy ACT (FOIP)
* Canadian Personal Information Protection and Electronic Documents Act (PIPEDA)
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What does the Protection for Persons in Care Act require?
requires the reporting of abuse, and promotes the prevention of abuse involving adult clients who receive publicly funded care or support services.
The PPC Act requires service providers to take reasonable steps to protect clients from abuse while providing care or support services.
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What does abuse constitute under the Persons Under Protective Care Act?
* “Abuse” now means an act or omission to a patient/client/resident receiving care or support service that:
* causes serious bodily or emotional harm,
* results in the administration, withholding or prescribing of medication for an inappropriate purpose, resulting in serious bodily harm,
* subjects an individual to non-consensual sexual contact, activity or behavior,
* involves misappropriating money or other valuable possessions,
* results in failing to provide adequate nutrition, medical attention or other necessities of life without valid consent, resulting in serious bodily harm
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Who can cause abuse?
* the patient/client/resident’s spouse, family member, or friend,
* a service provider’s employee,
* a volunteer, contractor, or other patient/client/resident or person.
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What is the role of service providers under the PPCA?
* They have the duty of taking reasonable steps to protect people from abuse while providing care for them.
* maintain a reasonable level of safety to the patient/client/resident
* take all reasonable steps to provide for the immediate safety, security and well being of a patient/resident/client for whom a report of abuse is made and for any other person who may be at risk of abuse when AHS is notified that a report of abuse has been made.
Note that the PPCA doesn’t apply if the abuse happened before receiving care or while they were not in AHS care or custody.
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What constitutes senior abuse in Canada?
* abuse takes the form of either **abuse** or **neglect** (either intentionally or unintentionally motivated), with the **locus of harm being physical, psychological, social, financial or sexual**.
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What are major risk factors “red flags” for seniors abude?
* Shared Living Situation
* Dementia
* Social Isolation
* Mental Health concerns and /or alcohol abuse by abuser
* Dependence of Abuser on Victim
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What assessments can be done related to seniors abuse?
• Psychiatric concerns/Psychiatric assessment • Cognitive screening • Physical assessment – bruising (Fig. 10-1 Miller) • Sexual assault • Referrals to appropriate programs and assessments • Patient and family teaching • Communications with other health professionals • Consider cultural aspects
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What constitutes low/medium risk of seniors abuse?
• Continual demands (not threats) on senior • Senior feels they cannot say no • Haven’t made the decision to set boundaries • Unhealthy family dynamics • Not willing to speak w/police but want ongoing emotional support • A lot of emotional/verbal and financial abuse cases.
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What constitutes high risk of seniors abuse?
There has been threats • Drugs and alcohol adding unpredictability to situation specifically around safety • Adult child is associated with other “bad” people (criminal types, gang members) • Concerns for senior physical safety • Escalating • Mental health issues (alleged abuser)
