chronic ill test 1 Flashcards
(99 cards)
1
Q
nursing process
A
assessment, diagnosis, planning, intervention, evaluation
2
Q
nursing management responsibilities
A
Staffing Employee satisfaction Safety and quality Customer satisfaction Budgeting
3
Q
nursing management skills
A
strong ability to make clinical decisions, priority setting, Organizational skills, Use of resources, Time management, Team communication
4
Q
car coordination includes
A
patient, provider, and care team
5
Q
care coordination
A
Care coordination is a necessary foundation to achieving the “triple aim” of health reform
6
Q
“triple aim” of health reform
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- Improved patient experience of care (quality, access, and reliability).
- Improved population health.
- Per capita cost control.
7
Q
what happens if care coordination isn’t involved
A
Increased cost Potential drug interactions Increased medical error Unnecessary duplication of tests and services Unnecessary patient and family distress
8
Q
what is chronic illness defined as
A
Persisting longer than 6 months
Irreversible
Affects functioning in one or more systems
9
Q
top chronic illnesses in the US
A
- Heart disease
- Cancer
- Chronic lung disease
- Stroke
- Alzheimer’s Disease
- Diabetes
- CKD
10
Q
how many adults in the US have a chronic illness
A
6 in 10 adults in the US have a chronic disease
11
Q
how many adults in the US have 2 or more chronic illness
A
4 in 10
12
Q
cost of chronic disease
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90% of the nation’s $3.3 trillion in annual health care expenditures are for people with chronic health conditions
13
Q
causes of chronic disease
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tobacco use, poor nutrition, lack of exercise, excessive alcohol use
14
Q
1 complication of chronic disease
A
depression
15
Q
other complications of chronic disease
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spiritual distress, fear, anxiety, and powerlessness
16
Q
spiritual patients and chronic illness
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Spiritual patients are able to find meaning and purpose in life and are better able to cope with and accept their chronic illness
17
Q
chronic illness management
A
1: Prevention of exacerbations - Imperative for patient’s to know the signs and symptoms of the onset of a crisis!
Carrying out prescribed treatment regimen
Controlling symptoms
CHF+ diuretics
Adjusting to changes in the course of disease
Prevent social isolation
18
Q
management of Patient with COPD
A
maintenance medications are key + sick day plan
19
Q
management of patient with CHF
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daily monitoring of weight and sodium intake + medication compliance
20
Q
8 phases of chronic illness
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- onset
- stable
- acute
- comeback
- crisis
- unstable
- downward
- dying
21
Q
phase 1 onset of chronic illness
A
Signs and symptoms are present
Disease diagnosed
22
Q
phase 2 onset of chronic illness
A
Illness course and symptoms controlled by treatment regimen
Person maintains everyday activities
23
Q
phase 3 onset of chronic illness
A
Active illness with severe and unrelieved symptoms or complications
Hospitalization may be required for management
24
Q
phase 4 onset of chronic illness
A
Gradual return to an acceptable way of life
25
phase 5 onset of chronic illness
Life-threatening situation occurs
| Emergency services are necessary
26
phase 6 onset of chronic illness
Unable to keep symptoms under control
| Life becomes disrupted while patient works to regain stability
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phase 7 onset of chronic illness
Gradual and progressive deterioration in physical or mental status
Continuous alterations in everyday life activities
28
phase 8 onset of chronic illness
Patient relinquishes everyday life interests and activities, let go, and die peacefully
Immediate weeks, days, hours preceding death
29
examples of community resources for chronic ill patients
```
School
Government
Non-profits
Faith-based organizations
All of these resources keep chronically ill patients supported, involved and active!
```
30
how are health systems involved in the chronic care model
Develop agreements that facilitate care coordination
Promote effective improvement strategies
Encourage open and systematic handling of errors and quality problems to improve care
31
Self-Management Support
Empower and prepare patients to manage their health care by Encouraging patients to set goals, identifying barriers and challenges, and monitoring their own conditions
32
Delivery System Design
Assure effective, efficient care and self-management support through Regular, proactive planned visits to maintain optimal health
33
decision Support
Promote care consistent with scientific data and patient preferences
34
Clinical Information Systems
Organize data to facilitate efficient and effective care
35
Upon initial diagnosis of a chronic illness, patient’s can experience the
5 stages of grief
36
5 stages of grief
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
Some stages may be revisited, and others may not be experienced at all
37
transition between stages is an
ebb and flow, NOT a progression
38
life alterations during a chronic disease
Behavioral and emotional changes
Impact on body image
Impact on self-concept
Impact on family
39
life alteration reactions depend on
1. The nature of the illness
2. Patient’s attitude
3. The reaction of others
4. Variables of illness behavior
40
illness behavior
how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the resources in the health care system
41
5 phases of adjustment in body image:
1. Shock
2. Withdrawal
* Withdrawal is an adaptive coping mechanism that helps the patient adjust
3. Acknowledgment
4. Acceptance
5. Rehabilitation
42
self concept
a mental self-image of strengths and weaknesses in all aspects of personality
43
As a nurse, if you observe changes in patient’s self-concept then
develop a care plan to help them adjust to the changes resulting from the illness
44
what is common in impact on families
Role reversal is common
45
impact on family dynamics
Parent becomes ill the family activities and decision making often come to a halt
The nurse views the WHOLE family to develop a care plan to help the family regain the maximal level of functioning and well-being
46
The Americans with Disabilities Act of 1990 (ADA)
makes it unlawful to discriminate in employment against a qualified individual with a disability
Employer must provide reasonable accommodation as needed
47
Work place issues vary greatly depending
on the level of disability and the job being performed
48
Having a chronic illness increases the likelihood of using
sick leave/time off
49
#1 chronic disease in the US
cardiovascular disease (CVD)
50
risk factors of CVD
smoking, high cholesterol, poor diet, drinking, inactivity, high blood pressure, family history, employment, housing, air pollution
51
management of HTN
- At both stage 1 and stage 2: encourage nonpharmacological therapies
- Dietary modifications (DASH diet)
- Physical activity
- Smoking cessation
- Pharmacologic treatment + medication compliance
52
DASH diet
grains, vegetables, fruits, unsalted nuts, lean meats, dried fruit, low fat plain yogurt
53
Pharmacologic treatment goal
SBP < 130mmHg
54
Strategies for Management of CAD
Medication compliance (statins)
Smoking cessation
Appropriate management of other chronic disease such as HTN and DM
55
Strategies for Management of MI/ACS
Timely medical intervention
ACS: door to balloon = 90 minutes
After intervention - CARDIAC REHAB
56
CVD: Prevention of Complications
Regular appointments with PCP and cardiologist
Medication compliance
Close monitoring of signs and symptoms
CHF: weight gain monitoring
57
Typical factors involved in worsening HF
Noncompliance with salt restriction
Pulmonary infectious processes
Use of antiarrhythmic agents
Arrhythmias
58
Early symptoms of HF exacerbations: (Think, FACES)
```
F= Fatigue
A = Activity limitation
C = Chest congestion/cough
E = edema
S = shortness of breath
```
59
COPD: Strategies for Management
Inhalers
60
OPD: Prevention of Complications
Medication compliance
Regular appointments with pulmonologist and PCP
Health promotion
pulmonary rehabilitation
61
Early signs of COPD exacerbations
Worsening dyspnea from baseline and/or ADLs
Increased sputum
Change in the color of sputum
Increased oxygen requirement
62
COPD Exacerbation Treatment
"Sick Day Plan”
| Antibiotic + Oral corticosteroid
63
CKD: Strategies for Management
Medication: Anti-hypertensive
Correction of extracellular fluid volume overload or deficit
Renal replacement therapy: dialysis
Nutritional therapy
64
CKD: Prevention of Complications
BP control, hyperglycemia control, adequate nutrition, primary prevention - vaccinations
65
DM: Strategies for Management
```
Monitoring blood glucose
Oral medications
nutritional therapy
exercise
insulin
```
66
DM: Acute Complications
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Diabetic Ketoacidosis (DKA) – caused by a profound deficiency of insulin. Characterized by:
1. Hyperglycemia
2. Ketosis
3. Acidosis
4. Dehydration
Hyperosmolar Hyperglycemic Syndrome (HHS) – characterized by:
1. Severe hyperglycemia
2. Osmotic diuresis
3. Extracellular fluid depletion
```
67
DM: Prevention of Other Complications
Educate patient on signs and symptoms and treatment of hypoglycemia
68
signs and symptoms and treatment of hypoglycemia
Cold, clammy skin
Faintness, dizziness
Hypoglycemia treatment = “rule of 15”
69
“rule of 15”
1. Eat or drink 15g of quick-acting carb (4-6oz regular soda or OJ, 5-8 LifeSavers)
2. Wait 15 min and check blood glucose
3. If blood glucose is still <70mg/DL, have patient repeat treatment of 15g of carbs
70
(HIV)
retrovirus that causes immunosuppression
71
AIDS
a diagnosis that is made when an HIV-infected patient meets criteria established by the CDC. These criteria occur when the immune system becomes severely compromised
72
HIV/AIDS – Strategies for Management and Prevention of Complications
adhering to Drug therapy, adopt a healthy lifestyle, protect others from HIV
73
#1 cancer in men
prostate cancer
74
#1 cancer in women
breast cancer
75
As RNs, we have an essential role in the prevention and early detection of cancer. How?
By eliminating risk factors
76
Colonoscopy screening guidelines (CDC, 2019)
Adults age 50-75
Every 10 years, unless abnormal
Adults >75 should ask their PCP
77
Cancer – Strategies for Prevention
RNs should educate patients to…
Limit alcohol use
Get regular physical activity
Obtain regular colorectal screenings
Get regular mammography screening and Pap tests
Avoid cigarette smoking and other tobacco use
Use sunscreen with a sun protection factor of 15 or higher
Practice healthy dietary habits, such as reducing fat consumption, avoiding processed meats, and increasing fruit and vegetable consumption
78
Seven Warning Signs of Cancer
C – change in bowel or bladder habits
A – a sore that does not heal
U – unusual bleeding or discharge from any body orifice
T – thickening or a lump in the breast or elsewhere
I – indigestion or difficulty in swallowing
O – obvious change in a wart or mole
N – nagging cough or hoarseness
79
primary cause of death in the patient with cancer
infection so Educate pt on signs and symptoms of infection
80
Overall goals for the patient with RA
1. Satisfactory pain management
2. Minimal loss of function of affected joints
3. Participate in planning and implementing therapeutic regimen
4. Maintain a positive self image
5. Perform self-care to the maximum amount possible
81
medication for RA
DMARDs
| NSAIDs
82
RA – Nursing Management and Prevention of Complications
```
ambulatory care - alternate rest and activity
joint protection
heat and cold therapy
exercise
psychological support
```
83
MS support
Onset usually between 20 and 50 years of age
| Women are affected 2-3x more than men
84
Overall goals for the patient with MS
1. Maximize neuromuscular function
2. Maintain independence in ADLs for as long as possible
3. Manage disabling fatigue
4. Optimize psychosocial well-being
5. Adjust to the illness
6. Reduce factors that precipitate exacerbations (e.g. infection, trauma, stress, change in climate)
85
Medications for MS
Disease-modifying drugs (Avonex)
Corticosteroids (for managing exacerbations)
Muscle relaxants (symptom management)
86
exercise for MS
Decreases spasticity, increases coordination, and retrains unaffected muscles to substitute for impaired ones - water exercise is beneficial
87
MG
Myasthenia Gravis - autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups
88
mean age of onset of MG
Mean age at onset in women is 28 years, men 42 years
| Women are affected more than men (3:2)
89
Overall goals for the patient with MG
1. Have a return of normal muscle endurance
2. Manage fatigue
3. Avoid complications
4. Maintain a quality of life appropriate to the disease course
90
MG treatment
Drug therapy:
- Anticholinesterase agents (enhance transmission of Ach)
- Corticosteroids
- Immunosuppressive agents
Surgery (thymectomy) – presence of the thymus gland in patient with MG enhances the production of Ach antibodies
91
MG exacerbation
myasthenia crisis
92
myasthenia crisis
an acute exacerbation of muscle weakness triggered by respiratory infection, surgery, emotional distress, or pregnancy
93
Prevention of myasthenia crisis
educate patient on signs and symptoms of respiratory infection
94
HBV
a blood-borne pathogen that can cause either acute or chronic hepatitis
95
HCV
RNA virus that is primarily transmitted percutaneously
96
Overall goals for the patient with HBV or HCV:
1. Have relief of discomfort
2. Be able to resume normal activities
3. Return to normal liver function without complications
97
Nursing implementation of HBV
identify those at risk, screen for HBV, vaccinate those who have not been infected
98
Nursing implementation HCV
no vaccine currently available. Therefore educate high-risk patients on using infection control precautions and modifying high-risk behavior
99
signs of cancer - CAUTION
change in bowel/bladder, a sore that doesn't heal, unusual bleeding or discharge, thickening of a lump, indigestion, obvious change in wart/mole, nagging cough
