chronic illness Final Exam Flashcards
(167 cards)
1
Q
Evidence based care improves
A
quality, safety, patient outcomes, nurse satisfaction, and reduced cost
2
Q
Steps to EBP
A
- ask a clinical question in PICOT format
- search for the most relevant and best evidence
- Critically appraise the evidence you gather
- Integrate all evidence with your clinical expertise and patient preferences and values
- Evaluate the outcomes of practice decisions or changes using evidence
- Share the outcomes of EBP changes with others
3
Q
PICOT
A
patient population of interest, intervention of interest, comparison of interest, outcome, time
4
Q
Expert Opinion
A
evidence from the opinion of authorities and/or reports of expert committees
5
Q
Case-Controlled Studies/Case Series
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identifies patients who have the outcome of interest (cases) and control patients, and looks for exposure of interest
6
Q
Cohort Study
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identifies 2 groups (cohorts) of patients, one which did receive the exposure of interest, and one which did not, and follows these cohorts forward for the outcome of interest
7
Q
RCTs
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randomized group of patients in an experimental group and a control group. These groups are followed up for the variables/outcomes of interest.
8
Q
Critically Appraised Articles
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authors evaluate and synopsize individual research studies
9
Q
Critically Appraised Topic
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authors evaluate and synthesize multiple research studies – check and balances system – a group of individuals look over the article and decide if it’s a good study
10
Q
Systematic Reviews
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authors have systematically searched for, appraised, and summarized all of the literature for a specific topic
11
Q
Meta-Analysis
A
a systematic review that uses quantitative methods to summarize the results
12
Q
in step three: Critically appraise the evidence you gather
you must determine
A
value
feasibility
usefulness of the evidence
13
Q
Validity
A
the degree to which methods are really measuring the concepts they are supposed to measure
14
Q
Reliability
A
the accuracy and consistency of information obtained in a study
15
Q
Bias
A
an influence that results in an error in an inference or estimate
16
Q
bias can effect
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the quality of evidence and the validity of the study
17
Q
Quantitative Nursing Research
A
The study of nursing phenomena that offers PRECISE measurement and quantification
Focuses on numerical data, statistical analysis, and controls to eliminate bias in findings
18
Q
Qualitative Nursing Research
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The study of phenomena that are difficult to quantify or categorize such as patients’ perceptions of illness or quality of life
Describes information obtained in a nonnumeric form
19
Q
examples of vulnerable populations
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Older adults Homeless Immigrant populations Children Severe mental illness Terminally ill or physically disabled
20
Q
Concepts to Consider when Conducting Research in Special Populations…
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powerlessness, vulnerability, self-concept, hardiness, resilience, wellness, quality of life
21
Q
Informed consent means that participants:
A
have adequate information about the research
can comprehend that information
have free choice in deciding whether to participate in or withdraw from the study
22
Q
Informed consent protects the rights of the research participant by meeting the rights to:
A
Self-determination
Privacy
Full disclosure
23
Q
Beneficence encompasses three duties
A
The duty to protect from (a) harm and (b) exploitation, and (c) duty to balance risks and benefits
24
Q
Researchers must protect study participants from all types of harm including
A
Physical, Psychological, Delayed effects of research that may be harmful
25
In general, research with vulnerable groups should be undertaken only when
1. The risk/benefit ratio is low OR
| 2. There is no alternative
26
An explicit health policy can achieve several things:
1. Defines a vision for the future
2. Outlines priorities and the expected roles of different groups
3. Builds consensus
4. Informs people
27
six steps of policy analysis
1. define and analyze problem
2. policy alternatives
3. evaluate criteria
4. assessment of alternatives
5. stakeholders
6. recommendations
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policy problem
existence of an unsatisfactory set of conditions for which relief is sought
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policy alternatives
no change, incremental change, comprehensive change
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incremental change
May be more feasible, but may not fully resolve the problem
31
Comprehensive/Major change
What alternative would provide EVERYTHING needed to resolve the problem?
32
evaluation criteria for policy
effectiveness, efficiency, equity, liberty, feasibility, acceptability
33
access to health services requires
1. Gaining entry into the health care system (usually through insurance coverage)
2. Accessing a location where needed health care services are provided (geographic availability)
3. Finding a health care provider whom the patient trusts and can communicate with
34
Access to health care impacts one’s
overall physical, social, and mental health status and quality of life
35
healthy people 2020 Focuses on 3 components of access to care
1. Insurance coverage
2. Health services
3. Timeliness of care
36
5 ways to improve access to health care are:
1. Retain Medicaid expansion and implement expansion in more states
2. Retain ACA reforms and stabilize individual insurance marketplaces
3. Address clinical workforce shortages
4. Telehealth and remote patient monitoring
5. Increase efficiency of existing workforce
37
health promotion
is a basic nursing function. we do this through:
1. individual counseling
2. public health education programs
3. provision of health service
38
primary prevention
intervening before health effects occur
Vaccinations
Altering risky behaviors (poor eating habits, tobacco use)
39
secondary prevention
screening to identify disease in the earliest stages, before the onset of signs and symptoms
Mammography
Regular blood pressure testing
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tertiary prevention
managing disease post diagnosis to slow or stop disease progression
Rehabilitation
Chemotherapy
41
disparity
differences in the presence of disease, health outcomes, or access to health care between population groups
42
inequity
unnecessary and avoidable differences in health that are considered unfair and unjust
43
5 Overarching recommendations for health promotion and disease prevention in vulnerable populations:
1. Promote health equity across racial, ethnic, and socioeconomic lines
Embed health equity into practices and policies
2. Provide federal resources to support state, local community-based prevention strategies
Reimburse community-based prevention
3. Tackle inequities of money, resources, etc.
4. Improve access to quality education
5. Invest in early childhood
44
Dr. Samuel Hahnemann came up with
Like cures Like” aka “The Principle of Similars”
45
examples of CAM
```
Acupuncture
Aromatherapy
Herbalism
Homeopathy
Hypnosis
Massage
Meditation
Reflexology
Reiki
```
46
Categories of CAM Therapies
Natural Products:
Herbs, vitamins, minerals, probiotics
Mind-Body Practice:
Acupuncture, massage therapy, meditation, movement therapies, spinal manipulation, yoga
Other:
Ayurvedic medicine, traditional Chinese medicine, homeopathy, naturopathy
47
conventional medicine
Treats human body in parts, not a whole
“Rescue Medicine”
Disease-based model
48
Complementary & Alternative Medicine
Approach to treatment is focused primarily on proactive measures
Treats the condition, not the symptoms
49
Integrative Medicine
The fusion of conventional medical practice and practices of complementary and alternative medicine.
50
CAM Principles of Care
Health & healing are related to a harmony of mind, body, & spirit
The body has the ability to heal itself
Basic positive health practices build the foundation of healing
Approaches to healing are individualized
Individuals are responsible for their own healing
51
Homeopathic Medicine: Patient Teaching
It is important to educate our patient’s on homeopathic medications that have been shown to interact with other drugs
52
CAM Therapies for emphysema
Nebulized glutathione (mother of all antioxidants)
53
CAM Therapies for cardiovascular disease
Co-enzyme Q10 – as we age Q10 decreases.
54
CAM Therapies for peripheral neuropathy
B vitamins (B12)
ALA (Alpha-lipoic acid)
Acupuncture
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CAM Therapies for Parkinson's disease
```
Amino acids (Tyrosine, Phenylalanine, Tryptophan)
B vitamins (B6 & Thiamine)
Glutathione
```
56
Black Cohosh (used for menopause to treat hot flashes) can have interactions with
Increased risk of liver toxicity if taken with atorvastatin, acetaminophen, or alcohol
57
Coenzyme Q10 should not be used with
anticoagulant drugs, decreases effectiveness of the anticoagulant and increases the risk of clots
58
Echinacea (stimulates immune system) interacts with
Slows caffeine breakdown leading to jitteriness, HA, or insomnia
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Evening Primrose Oil (fatty acids used by the body for growth) should not be taken with
Increases risk of seizures in patient’s taking anti-convulsants
60
St. John’s Wort (used for symptoms of depression) Contraindicated when
Contraindicated when used concomitantly with SSRIs, MAOIs, tricyclic antidepressants, warfarin, and birth control
61
hospice care
Used for terminally ill patients when treatment is no longer curative during the last 6 months of life, assuming the disease takes its natural course
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palliative care
Addresses the patient’s physical, emotional, and spiritual needs (just like hospice), however palliative care is also focused on relieving symptoms associated with the patient’s condition while receiving active treatment
63
Hospice and insurance
paid in full by the Medicare Hospice Benefit and by Medicaid Hospice Benefit. Most insurances and VA also cover in full or with minimal co-pays
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palliative care and insurance
paid by Medicare, Medicaid, and most private insurances IF the patient meets criteria
65
physical changes during end of life
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Incontinence
Loss of appetite
Semi consciousness
Dysphagia
Changes in respiratory pattern
-Cheyne Stoke
Mottled skin
```
66
nursing management during end of life
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Comfort
-Pain management
Oral care – sponge swabs
-Keeps oral mucosa moist
Positioning
-Raising bed to semi fowlers
Terminal respiratory secretions (“Death Rattle”)
-Scopalamine
Warm blankets
Family support
```
67
types of forms used in end of life
Advanced Directives:
Durable Power of Attorney for Healthcare
Durable Power of Attorney for Finances
Living Will
2. POLST
3. Will
4. Living Trust
68
Advanced Directives – Durable Power of Attorney for Healthcare
legal document that authorizes someone you trust to make medical decisions on your behalf
69
Advanced Directives – Durable Power of Attorney for Finances
Gives an individual the authority to perform certain specified acts on behalf of the principal even if that person becomes disabled or legally incapacitated
70
Advanced Directives – Living Will
A written statement detailing a person’s desires regarding their medical treatment in circumstances in which they are unable to express their consent or wishes
71
A Living Will Specifies
```
DNR
DNI
IV Fluids
NG Tube/PEG Tube
Pain Medications
```
72
POLST
Physician Order for Life-Sustaining Treatment
73
3 key features of a POLST
1. Completed WITH your healthcare professional to direct the kinds of treatment you want in a medical crisis
2. Becomes a medical order after signed by you and your PCP
3. POLST travels with the patient
74
Medicare will pay for ____________ to discuss a POLST
a 30 minute appointment with PCP
75
Difference between a POLST and living will
911 obligated to resuscitate you if you are not in the hospital UNLESS they receive definitive information on the contrary
POLST = an order for a MD that applies even out of the hospital
76
Living Trust
A living trust provides lifetime and after-death property management
77
nursing management responsibilities
```
Staffing
Employee satisfaction
Safety and quality
Customer satisfaction
Budgeting
```
78
car coordination includes
patient, provider, and care team
79
care coordination
Care coordination is a necessary foundation to achieving the “triple aim” of health reform
80
“triple aim” of health reform
1. Improved patient experience of care (quality, access, and reliability).
2. Improved population health.
3. Per capita cost control.
81
what happens if care coordination isn't involved
```
Increased cost
Potential drug interactions
Increased medical error
Unnecessary duplication of tests and services
Unnecessary patient and family distress
```
82
what is chronic illness defined as
Persisting longer than 6 months
Irreversible
Affects functioning in one or more systems
83
top chronic illnesses in the US
1. Heart disease
2. Cancer
3. Chronic lung disease
4. Stroke
5. Alzheimer’s Disease
6. Diabetes
7. CKD
84
causes of chronic disease
tobacco use, poor nutrition, lack of exercise, excessive alcohol use
85
#1 complication of chronic disease
depression
86
other complications of chronic disease
spiritual distress, fear, anxiety, and powerlessness
87
chronic illness management
#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
88
management of Patient with COPD
maintenance medications are key + sick day plan
89
management of patient with CHF
daily monitoring of weight and sodium intake + medication compliance
90
8 phases of chronic illness
1. onset
2. stable
3. acute
4. comeback
5. crisis
6. unstable
7. downward
8. dying
91
phase 1 onset of chronic illness
Signs and symptoms are present
| Disease diagnosed
92
phase 2 onset of chronic illness
Illness course and symptoms controlled by treatment regimen
| Person maintains everyday activities
93
phase 3 onset of chronic illness
Active illness with severe and unrelieved symptoms or complications
Hospitalization may be required for management
94
phase 4 onset of chronic illness
Gradual return to an acceptable way of life
95
phase 5 onset of chronic illness
Life-threatening situation occurs
| Emergency services are necessary
96
phase 6 onset of chronic illness
Unable to keep symptoms under control
| Life becomes disrupted while patient works to regain stability
97
phase 7 onset of chronic illness
Gradual and progressive deterioration in physical or mental status
Continuous alterations in everyday life activities
98
phase 8 onset of chronic illness
Patient relinquishes everyday life interests and activities, let go, and die peacefully
Immediate weeks, days, hours preceding death
99
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!
```
100
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
101
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
102
Delivery System Design
Assure effective, efficient care and self-management support through Regular, proactive planned visits to maintain optimal health
103
decision Support
Promote care consistent with scientific data and patient preferences
104
Clinical Information Systems
Organize data to facilitate efficient and effective care
105
Upon initial diagnosis of a chronic illness, patient’s can experience the
5 stages of grief
106
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
107
transition between stages is an
ebb and flow, NOT a progression
108
life alterations during a chronic disease
Behavioral and emotional changes
Impact on body image
Impact on self-concept
Impact on family
109
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
110
illness behavior
how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the resources in the health care system
111
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
112
self concept
a mental self-image of strengths and weaknesses in all aspects of personality
113
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
114
what is common in impact on families
Role reversal is common
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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
116
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
117
Work place issues vary greatly depending
on the level of disability and the job being performed
118
Having a chronic illness increases the likelihood of using
sick leave/time off
119
#1 chronic disease in the US
cardiovascular disease (CVD)
120
risk factors of CVD
smoking, high cholesterol, poor diet, drinking, inactivity, high blood pressure, family history, employment, housing, air pollution
121
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
122
DASH diet
grains, vegetables, fruits, unsalted nuts, lean meats, dried fruit, low fat plain yogurt
123
Pharmacologic treatment goal
SBP < 130mmHg
124
Strategies for Management of CAD
Medication compliance (statins)
Smoking cessation
Appropriate management of other chronic disease such as HTN and DM
125
Strategies for Management of MI/ACS
Timely medical intervention
ACS: door to balloon = 90 minutes
After intervention - CARDIAC REHAB
126
CVD: Prevention of Complications
Regular appointments with PCP and cardiologist
Medication compliance
Close monitoring of signs and symptoms
CHF: weight gain monitoring
127
Typical factors involved in worsening HF
Noncompliance with salt restriction
Pulmonary infectious processes
Use of antiarrhythmic agents
Arrhythmias
128
Early symptoms of HF exacerbations: (Think, FACES)
```
F= Fatigue
A = Activity limitation
C = Chest congestion/cough
E = edema
S = shortness of breath
```
129
COPD: Strategies for Management
Inhalers
130
COPD: Prevention of Complications
Medication compliance
Regular appointments with pulmonologist and PCP
Health promotion
pulmonary rehabilitation
131
Early signs of COPD exacerbations
Worsening dyspnea from baseline and/or ADLs
Increased sputum
Change in the color of sputum
Increased oxygen requirement
132
COPD Exacerbation Treatment
"Sick Day Plan”
| Antibiotic + Oral corticosteroid
133
CKD: Strategies for Management
Medication: Anti-hypertensive
Correction of extracellular fluid volume overload or deficit
Renal replacement therapy: dialysis
Nutritional therapy
134
CKD: Prevention of Complications
BP control, hyperglycemia control, adequate nutrition, primary prevention - vaccinations
135
DM: Strategies for Management
```
Monitoring blood glucose
Oral medications
nutritional therapy
exercise
insulin
```
136
DM: Acute Complications
```
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
```
137
DM: Prevention of Other Complications
Educate patient on signs and symptoms and treatment of hypoglycemia
138
signs and symptoms and treatment of hypoglycemia
Cold, clammy skin
Faintness, dizziness
Hypoglycemia treatment = “rule of 15”
139
“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
140
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
141
HIV/AIDS – Strategies for Management and Prevention of Complications
adhering to Drug therapy, adopt a healthy lifestyle, protect others from HIV
142
#1 cancer in men
prostate cancer
143
#1 cancer in women
breast cancer
144
As RNs, we have an essential role in the prevention and early detection of cancer. How?
By eliminating risk factors
145
Colonoscopy screening guidelines (CDC, 2019)
Adults age 50-75
Every 10 years, unless abnormal
Adults >75 should ask their PCP
146
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
147
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
148
primary cause of death in the patient with cancer
infection so Educate pt on signs and symptoms of infection
149
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
150
medication for RA
DMARDs
| NSAIDs
151
RA – Nursing Management and Prevention of Complications
```
ambulatory care - alternate rest and activity
joint protection
heat and cold therapy
exercise
psychological support
```
152
MS support
Onset usually between 20 and 50 years of age
| Women are affected 2-3x more than men
153
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)
154
Medications for MS
Disease-modifying drugs (Avonex)
Corticosteroids (for managing exacerbations)
Muscle relaxants (symptom management)
155
exercise for MS
Decreases spasticity, increases coordination, and retrains unaffected muscles to substitute for impaired ones - water exercise is beneficial
156
MG
Myasthenia Gravis - autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups
157
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)
158
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
159
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
160
MG exacerbation
myasthenia crisis
161
myasthenia crisis
an acute exacerbation of muscle weakness triggered by respiratory infection, surgery, emotional distress, or pregnancy
162
Prevention of myasthenia crisis
educate patient on signs and symptoms of respiratory infection
163
HBV
a blood-borne pathogen that can cause either acute or chronic hepatitis
164
HCV
RNA virus that is primarily transmitted percutaneously
165
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
166
Nursing implementation of HBV
identify those at risk, screen for HBV, vaccinate those who have not been infected
167
Nursing implementation HCV
no vaccine currently available. Therefore educate high-risk patients on using infection control precautions and modifying high-risk behavior
