Exam 3

Question 1

Managing Physiologic Responses to Terminal Illness

Answer 1

-Pain:
Establish a regimen of analgesics to provide optimal pain relief
-Dyspnea:
Treat underlying pathology, monitor response, manage anxiety, conserve energy
-Nutrition and Hydration:
Anorexia vs. cachexia
Family may want to make their favorite meal, and the patient doesn’t like it.
-Delirium:
Treat underlying factors contributing to delirium
Change in the last 24 hours that is drastic. (Change in medications, infections, electrolytes that are off). Correctible problems, need to have it treated.
-Depression:
Emotional, spiritual and medical support

Question 2

Dying

Answer 2

-Some people decline gradually others go quickly
-There are changes you can expect to see as the body stops working.
-Children and teens can stay fairly active until near the end.
-1 to 3 months before death:
Sleep or doze more
Eat and drink less
Withdraw from people and stop doing things they usually do
Talk less or at times need to talk more

Question 3

What is seen 1 to 2 weeks before death?

Answer 3

• May feel tired or drained all the time and spend more time in bed
• Change in sleep-wake patterns
• Little appetite and thirst or even interest in these, therefore less urine and stool output
• Changes in blood pressure, breathing and heart rate
• Body temperature dysregulation: cool, warm, moist or pale skin
• Congested breathing: If they have congested breathing we can suction, but not deep suction into the trachea.
• Confusion or seem in a daze
• May have more pain

Question 4

Days to hours before death

Answer 4

Not wanting food or drink
Stop having urine output or stool
Grimace, groan or scowl 
Unfocused gaze
May seem to drift in and out of awareness
Irregular or week pulse
Rapid or Cheyne-Stokes breathing until there is none
Skin cool or mottled

Question 5

Care of the body after death

Answer 5

-Organ and tissue donation: The floor nurse caring for the patient does not broach this subject. You MUST call a specially trained professional.
-Autopsy: Can be requested or required.
Required if cause of death is the result of criminal violence, suicide, accidental cause (car accident), suspicious death, work place injury, suspected drowning, unexpected death of an infant or child, or while in custody of the police or a local, state or federal institution.
Can be requested by a family for other reasons, but they must pay for it.
-You have to listen for a heart beat for a couple of minutes. We do not fill out the death certificate or determine the cause of death. Two nurses can pronounce the death.
-If the person dies of criminal activity or unobserved death then they cannot remove any of the tubes. They can cut it but leave it in so that the coroner can tell whether the damage done was done my intubation or by other things the nurse has done rather than the initial cause of injury.

Question 6

Post Mortem Care

Answer 6

-Ensure that the family or loved ones wishes, rituals or customs are respected whenever possible.
-Allow them to assist with final bathing of the body if they desire
-Physical changes in the body can set in rapidly:
Close the eyes and mouth. Leave denture in to support the shape of the mouth.
Remove tubes and IV unless autopsy required
Clean the body and cover with a clean sheet with arms on the outside.
Elevate the HOB some to prevent discoloration of the face.
Place padding under the body in case sphincters relax-No diaper
-Allow the family or loved ones all the time they need with the body.
-Give jewelry and personal property of the deceased to the family and have them sign the appropriate forms.
-Ask the family if they have made arrangements with a mortuary or if they would like you to call one of their choosing.
-Contact the mortuary and they will usually come to pick up the body.
-Contact the appropriate personnel to take the body to the hospital morgue.

Question 7

Grief

Answer 7

• Loss, Grief, and Bereavement
• Loss: losing a loved one
• Grief: personal feelings that accompany an anticipated or actual loss
• Stage of grief (Kubler-Ross and other grief theories): People don’t move through the stages of grief in a linear fashion, it loops back and forth over time.
• Mourning: individual, family, group and cultural expressions of grief and associated behaviors
• Bereavement: period of time in which mourning takes place
• Professional caregivers are not immune to grief!
• Our care turns from the patient to the family.

Question 8

Grieving

Answer 8

• Does not follow a prescribed course.
• Just be present-don’t offer platitudes
• Highly visible losses generally stimulate help from others.
• Grief may come out as anger-don’t take it personally
• Grief work is just that, work.
• Refer people to grief resources such as Solace House

Question 9

Spirituality

Answer 9

• Ask him or her if you and the health care team met their expectations and if there is anything else you can do to enhance their spiritual well-being or enable them to practice important religious rituals.
• Most health care workers are uncomfortable talking about spirituality and beliefs.
• Most hospitals have a pastoral care office-use this resource.
• An individuals spiritual beliefs are very personal. Avoid making assumptions even if you think you are of the same faith or if you have studied about different faith traditions that that individual follows it the same way as others.
• Be sure not to preach. The hospital isn’t the place.
• Are your spiritual needs being met? Can we do anything to meet them?

Question 10

rituals

Answer 10

• Rituals help express a communal emotion in a shared way
• Late 19th century- memorials for deaths and took pictures with the dead
• think about: What would I want for my death?

Question 11

Palliative care

Answer 11

• An approach to care of the seriously and/or chronically ill that is comprised of comprehensive symptom management, psychological care, and spiritual support to enhance quality of life.
• can be provided along with curative treatment and does not depend on prognosis.
  a resource for anyone living with a serious - illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others.
• Palliative care can be helpful at any stage of illness and is best provided from the point of diagnosis.
• In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment.
• The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.
• Palliative care can be provided along with curative treatment and does not depend on prognosis.

Question 12

WHO-World Health Organization & death and dying

Answer 12

• Affirms life and regards dying as a normal process.
• Neither hastens or postpones death.
  Integrates psychological and spiritual aspects of care.
• Offers a support system to help patients live as actively as possible until death.
• Enhances the quality of like.
• Uses a team approach to meet the needs of patient and families.
• Expresses nursing attitude

Question 13

Palliative Care Trigger Tool (just know this exists)

Answer 13

Does this patient meet any of the following criteria?: (Check all that apply)

• DNR/DNI
• Would not be surprised if the patient died within 12 months.
• ICU stay > 7days, readmission to ICU within 30 days with same diagnosis
• Two or > hospitalizations for the same illness within 3 months
• Admission from long-term care facility or medical foster home
• Prolonged dysfunction of multiple organs (MODS)
• Advanced dementia (bedbound and non-verbal)
• Intracerebral Hemorrhage requiring mechanical ventilation
• Unsuccessful wean and/or prolonged ventilator dependence

Question 14

Hospice

Answer 14

• A coordinated comprehensive program of holistic interdisciplinary services provided by professional care givers and trained volunteers to terminally ill patient and their families at the end of life.
• provided for a person with a terminal illness whose doctor believes he or she has 6 months or less to live if the illness runs its natural course.
• Someone is available 24/7 for support, but the patient must have a family caregiver to provide care when the patient is no longer able to function alone.

Question 15

Hospice: core principles

Answer 15

• Provision of interdisciplinary care. Medical and nursing services available at all times.
• Affirms life, but never denies death as a normal process of life.
• Education and support is provided, it honors wishes and supports choices.
• The patient and family are a unit of care.
• A physician-directed service.
• Bereavement follow-up after patient’s death.
• Home care of the dying is preferred.

Question 16

Support system for dying patients

Answer 16

• nurse
• hospice aide
• social worker: Can assist with finding resources for legal and financial needs.
• chaplin
• grief support
• volunteer
• your personal physician
• hospice physician

Question 17

Barriers to Improving End of Life Care

Answer 17

Clinicians’ Attitudes toward Death & Dying:
Reluctant to discuss death with patients
Avoid discussion in hopes patient would discover on their own
Awareness contexts
Communication:
Providing bad news
Responding to difficult questions
. They may feel that their job is to fix or cure and death represents a failure.

Question 18

Glaser and Strauss’ four awareness contexts of the patient, provider and family in regards to discussion of terminal illness or death and dying

Answer 18

. Closed awareness is when the patient is unaware of their terminal state but others are aware.

• Suspected awareness is when the patient suspects what others know and attempts to find out details about their current health condition.
• Mutual pretense awareness is when the patient, the family and the providers are all aware that the patient is dying but all pretend otherwise.
• Open awareness is when the patient, family, and provider are aware the patient is dying and openly acknowledge that reality.
• Communication may also be a barrier to improving end of life care particularly if providers do not know how to respond when providing bad news to patients or responding to difficult questions regarding prognosis.

Question 19

Methods of Stating End-of-Life Preferences

Answer 19

Advance directives:

• Written documents, individual of sound mind
• Document preferences regarding EOL care to be followed when individual cannot communicate their wishes
• The documents are generally completed in advance of serious illness, but may be completed after a diagnosis of serious illness if the signer is still

Durable power of attorney for health care:

• Legal document
• Signer appoints another to make medical decisions on his/her behalf
• make medical decisions on his or her behalf when he or she is not longer able to speak for him or herself. This is also known as a health care power of attorney or a proxy directive.

Living will:
- Individual documents treatment preferences
Provides instructions for care when individual cannot communicate wishes
- This is also known as a medical directive or treatment directive.

Physician Orders for Life-Sustaining Treatment (POLST):

• Translates patient preferences expressed in advance directives to medical orders that are transferrable across settings and readily available to all health care providers including emergency medical personnel.
• Sometimes advance directives are barriers to improving end of life care for patients because these documents must be followed even if it could potentially result in decreased QOL for the patient.

Question 20

Infants and Toddlers with death and dying

Answer 20

• Gauging pre-verbal children and their view of death is impossible
• No concept of death based on their cognitive abilities
• Egocentricity of toddlers and their vague separation of fact and fantasy make it impossible for them to comprehend the “absence of life”
• May repeat the statement, “Grandpa is dead; he went to heaven,” but may still expect him to return over a period of a few months
• Behavior related to reacting to their parents’ reactions and anxiety
  regression in speech, toileting, Crying, control with food and drink, hitting, biting, with drawl
  Encourage parents to stay with the patients as often as possible!

Interventions for this population include:

• Physical comfort
• Consistent caregivers/routine
• Familiar objects
• Family needs of children of all ages:
• Feelings of anger, guilt, anxiety, and helplessness are normal
• They worry about pain and comfort of their child
• Help families identify that their feelings are normal and identify ways to cope
• Respite, seek assistance out side of the family

Question 21

Preschool Children 3-5yr with death and dying

Answer 21

• Egocentric and have a tremendous sense of self-power
• Believe their thoughts can cause actions
• Struggle with the meaning of “Death”, may see it as a departure or sleep, reversible
• Often will feel that they are sick as a punishment for being bad, especially if parents are unable to stay with them or be present during painful procedures
• Greatest fear of death is separation from parents
• Play provides the preschooler with relief from feelings of grief
• very literal. Telling them “grandma went to sleep” could cause fear that if they go to sleep that they will be gone from everyone just as Grandma is.
• Important to remember that sibling have needs too.
• Developmental level must be considered
• Displaced and isolated in the process
• Feelings of being left out
• Nurses and Child Life can help identify ways to involve the siblings in the caring process
• All interaction with the dying sibling when possible
• Encourage devoted time to the well siblings
• Identify family member or friend to sit with the sibling to keep them busy
• A lot of care goes to caregivers
• Provide consistent caregiver and routine
• Include siblings
• Encourage playtime

Question 22

School Age children 6-12

Answer 22

• Better understanding of causality and advanced perception of time
• May still associate misdeeds or bad thoughts with causing death
• Clarify the meaning of their statements!!
• Death is personified as devil, God, ghost or boogeyman
• Preoccupied with details: “When you die your body decays in the ground.”
• Understanding that death is universal, irreversible, and nonfunctional
• Attitude towards death are influenced by attitudes and reactions of others
• It is very important for parents to clarify the meaning of their statements and to repeatedly ask the child what they think and what things mean to them.
• Realize death is permanent
• askWhat do you already know?

Fear:
- Reason for illness
- Communicability of the disease to themselves or others
- Consequences of the disease on functioning and relationships
- Process of dying is often more scary than the finality of death
Anticipatory preparation:
- Industry: help give them control
- Understand what is happening
- Participate in what is being done and what to stop and when
Behavior:
- Exhibit fear through verbal uncooperativeness
- Staff could interpret as stubborn, rude, impolite
- Plea for control, “fight or flight”

Question 23

Adolescent Children 13-17 yrs with death and dying

Answer 23

• Strive for group acceptance and independence from parent constraints
• May feel alienated from peer associates and lean on them for emotional support
• Feeling of being alone
• Support groups or other means of networking are great for this group.
• Mature understanding of death
• Question death and related topics: Religious meaning, Afterlife
• Difficult to accept/cope because of formation of identity
• Tend to think they will NEVER die young
• Allow for as much self-control and independence as possible
• Answer questions HONESTLY! They will call BS on you and never trust you AGAIN!
• Respect their need for privacy, solitude, and personal expression of emotions
• Help facilitate conversations between parents and child
• THIS in many ways is how we as adults deal with death. You never can read someone’s mind.
• Key Points: Listen, Ask, don’t judge, don’t assume and DON’T TAKE IT PERSONALLY

Question 24

Oxygenation Assessment

Answer 24

• In-depth history of a patient’s normal and present cardiopulmonary function
• Past impairments in circulatory or respiratory functioning
• Methods that a patient uses to optimize oxygenation
• Review of drug, food, and other allergies
• Physical examination
• Laboratory and diagnostic tests

Question 25

Oxygenation: Assessment History

Answer 25

- Pain - Fatigue - Cough - Wheezing - Environmental/geographical exposures - Smoking - Respiratory infections - Allergies - Health Risks

Question 26

Oxygenation: Physical Assessment

Answer 26

- Inspection, Palpation, Percussion, Auscultation - Observe the rate, depth, rhythm, and quality of respirations - Note the position the client assumes when breathing

Question 27

Pulse Oximetry

Answer 27

-Monitor patient’s oxygen saturation(SaO2) by using a pulse oximeter - Pulse Oximetry Findings: - Expected range is 95-100% - Acceptable levels are 91-100%

Question 28

Pulse Oximetry Interventions

Answer 28

- If less than 90%: - Confirm probe placement - Check oxygen delivery system - Place client in semi-fowler’s or fowler’s position - Encourage deep breathing - Remain with client to reduce anxiety

Question 29

Hyperventilation

Answer 29

- Lungs remove carbon dioxide faster than it is produced by cellular metabolism - Caused by anxiety, drugs, acid-base imbalance, fever, or chemically can induce - Measure by ABG - S/S include rapid respirations, sighing breaths, numbness and tingling of the hands/feet, light-headedness, loss of consciousness

Question 30

Hypoventilation

Answer 30

- Occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide - Can be caused by slow or shallow breathing, diseases of the respiratory muscles, drugs, or anesthesia - Determine by ABG - S/S include mental status changes, dysrhythmias, potential cardiac arrest

Question 31

Hypoxia

Answer 31

- Caused by: - Decreased hemoglobin level - Diminished level of inspired O2 - Inability to extract oxygen from the blood - Decreased diffusion of oxygen from the alveoli to the blood(pneumonia) - Poor tissue perfusion(shock) - Impaired ventilation(rib fractures or chest trauma)

Question 32

Hypoxia Signs and Symptoms

Answer 32

- Apprehension and restlessness - inability to concentrate - decreased level of consciousness and dizziness - behavioral changes - increased pulse rate and depth of respiration - dysrhythmias - cyanosis ``` Symptoms: RAT BED Restlessness Anxiety Tachycardia/Tachypnea Bradycardia Extreme Restlessness Dyspnea (Severe) ``` ``` Pediatric Symptoms: FINES Feeding difficulty Inspirator stridor Nare Flare Expiratory Grunting Sternal Retractions ```

Question 33

Hypoxia

Answer 33

- Caused by: - Decreased hemoglobin level - Diminished level of inspired O2 - Inability to extract oxygen from the blood - Decreased diffusion of oxygen from the alveoli to the blood(pneumonia) - Poor tissue perfusion(shock) - Impaired ventilation(rib fractures or chest trauma)

Question 34

Hypoxia Signs and Symptoms

Answer 34

- Apprehension and restlessness - inability to concentrate - decreased level of consciousness and dizziness - behavioral changes - increased pulse rate and depth of respiration - dysrhythmias - cyanosis ``` Symptoms: RAT BED Restlessness Anxiety Tachycardia/Tachypnea Bradycardia Extreme Restlessness Dyspnea (Severe) ``` ``` Pediatric Symptoms: FINES Feeding difficulty Inspirator stridor Nare Flare Expiratory Grunting Sternal Retractions ```

Question 35

Cyanosis

Answer 35

- Blue discoloration of the skin and mucous membranes - Caused by desaturated hemoglobin - Late sign of hypoxia

Question 36

Nursing Diagnosis/Patient problem related to oxygenation

Answer 36

- activity intolerance - decreased cardiac output - fatigue - impaired gas exchange - impaired verbal communication - impaired verbal communication - ineffective airway clearance - risk for aspiration - ineffective breathing pattern - ineffective health maintenance

Question 37

Planning (oxygenation)

Answer 37

- During planning, use critical thinking skills to synthesize information from multiple sources - Goals and outcomes - Realistic expectations, goals, and measurable outcomes - Setting priorities - Teamwork and collaboration

Question 38

Acute Care Interventions for oxygenation

Answer 38

- Dyspnea management-manage/determine underlying cause, treat with oxygen therapy or medications(such as inhalers) - Airway maintenance- requires adequate hydration to prevent thick, tenacious secretions. The best way to maintain thin secretions is adequate fluid intake of 1500-2500ml/day. The nurse can determine hydration by looking at the color, consistency and ease of mucus expectoration. - Humidification is the process of adding water to gas, necessary for patients receiving greater than 4L via nasal cannula. May also be necessary to add to lower amounts of oxygen if the air is dry. Bubbling oxygen through water adds humidity. - Nebulization adds moisture or medications to air by mixing particles with the air. It improves the clearance of pulmonary secretions. It is used for the administration of bronchodilators and mucolytic agents to the patient. aerosol - mobilization of secretions- Postural drainage consists of drainage, positioning, and turning to aid is mobilizing secretions. High-fowlers is most often used for bilateral drainage. In the presence of pulmonary abscess or hemorrhage, position the patient with the affected lung down to prevent drainage toward the healthy lung. For bilateral lung disease, the best position depends on the severity of the disease. - Coughing and Deep Breathing techniques - Ambulation- Encourage early ambulation to promote lung expansion - immobility is a major factor in developing atelectasis, ventilator associated pneumonia and functional limitations. After one week of bedrest muscle strength declines by as much as 20% which results in increased 02 demand and weakened respiratory muscles. Encourage and assist to sit, dangle, stand and walk. - Positioning- Frequent changes in position, semi or high fowler’s position - Frequent changes of position are simple and cost-effective methods for reducing stasis of pulmonary secretions and decreased chest wall expansion, both of which increase the risk of pneumonia. The 45-degree semi-Fowler’s is the most effective position for promoting lung expansion and reducing pressure from the abdomen on the diaphragm.

Question 39

Coughing Techniques

Answer 39

- quad cough - huff cough stimulates a natural cough reflex and is generally effective only for clearing central airways. While exhaling, the patient opens the glottis by saying the word huff. With practice the patient inhales more air and is able to progress to the cascade cough. - The quad cough technique is for patients without abdominal muscle control such as those with spinal cord injuries. While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm, causing the cough. Cascade cough the patient takes a slow, deep breath and holds it for 2 seconds while contracting expiratory muscles. Then the patient opens the mouth and performs a series of coughs throughout exhalation, thereby coughing at progressively lowered lung volumes. This technique promotes airway clearance and a patent airway in patients with large volumes of sputum.

Question 40

Breathing excercises- pursed lip breathing

Answer 40

- Deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse - Instruct the patient to sit up, take a deep breath and exhale slowly as if they are breathing through a straw

Question 41

Breathing Exercises- Diaphragmatic breathing

Answer 41

- Relaxing intercostal and accessory respiratory muscles while taking deep inspirations - Place one hand on the breastbone and the other hand on the abdomen - Inhale slowly making the abdomen push out, exhale and the abdomen should go - Diaphragmatic breathing/belly breathing is a technique that encourages deep breathing to increase air to the lower lungs.

Question 42

Incentive Spirometry

Answer 42

- 5-10 breaths per session every hour while awake - Encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume. - It promotes deep breathing and prevents or treats atelectasis in the postoperative patient. - There is solid evidence to support the use of lung expansion with incentive spirometry in preventing postoperative pulmonary complications following surgery. - encourages patients to use visual feedback to maximally inflate their lungs and sustain that inflation.

Question 43

Diagnostic studies for oxygenation (dont need to know, just be familiar)

Answer 43

- Arterial Blood Gases-provides information for assessment of patient’s respiratory and metabolic acid/base balance and adequacy of oxygenation. Taken from the radial, brachial or femoral arteries - Pulmonary Function Test-determines the ability of the lungs to efficiently exchange oxygen and carbon dioxide, used to differentiate pulmonary obstructive from restrictive disease Peak expiratory Flow rate-reflects change in large airway sizes, good predictor of overall airway resistance. - Sputum specimen-can be for culture and sensitivity testing(identifies drug resistance to determine correct antibiotic), acid-fast bacillus(detection of TB), or cytology(identify lung CA-differentiates types of cancer cells) - chest X-ray

Question 44

Implementation: Health Promotion (oxygenation)

Answer 44

- Vaccinations: Influenza, pneumococcal - Healthy lifestyle- Eliminating risk factors, eating right, regular exercise - Environmental pollutants- Secondhand smoke, work chemicals, and pollutants

Question 45

Maintenance and Promotion of Oxygenation

Answer 45

- Oxygen therapy- To prevent or relieve hypoxia - Supply of oxygen- Tanks or wall-piped system - Methods of oxygen delivery: Nasal cannula Oxygen masks

Question 46

education on O2 Therapy

Answer 46

- Secure tanks so they don’t fall over - Check portable cylinders before use - Check oxygen tubing length for patient needs - Determine that all electrical equipment in the room is functioning properly - Keep oxygen-delivery systems 10 feet from any open flames

Question 47

methods of oxygen delivery- nasal canula

Answer 47

- Simple device used for oxygen delivery - Can deliver 1-6L of oxygen Nursing Actions: - Assess patency of nares - Ensure a proper fit - Greater than 4L needs to be humidified

Question 48

advantages and disadvantages of nasal canulas

Answer 48

Advantages: - Safe and simple to use - Easily tolerated - Delivers low concentrations of oxygen while allowing patients to eat, drink, speak and drink - Disposable Disadvantages: - Can have a drying effect - Can dislodge easily - Monitor for skin breakdown over the ears and nostrils - can have a drying effect if greater than 4L/min

Question 49

Methods of oxygen delivery: simple face mask

Answer 49

- Minimum flow rate of 5L/min - Delivers 5-8L/min Nursing Actions: - Assess proper fit for a secure fit over nose and mouth - Nasal cannula during meals - Monitor for skin breakdown

Question 50

advantages and disadvantages of simple face mask

Answer 50

Advantage: - easy to apply - Simple delivery method Disadvantage: - flow rates less than 5L/min can result in rebreathing CO2 - Not for anxious or claustrophobic patients - Eating, drinking and talking are impaired - Potential for skin breakdown due to moisture and pressure

Question 51

suctioning

Answer 51

adult: a long dentist tool looking thing infant/pediatric: mom sucks in through mouth? bulb nose suction - WTF?

Question 52

breathing patterns

Answer 52

- Tachypnea: Greater than 20 breaths per minute - Bradypnea: Less than 12 breaths per minute - Apnea: Absence of breathing for 15 seconds or longer - Orthopnea: abnormal condition in which it is easier to breathe when sitting up or leaning forward - Dyspnea: Subjective sensation of difficult or uncomfortable breathing

Question 53

Structure and function of ventilation and perfusion

Answer 53

Ventilation - Process of moving gases into and out of the lungs - Requires coordination of the muscular and elastic properties of the lung and thorax Perfusion - The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs - Responsible for moving the respiratory gases from one area to another

Question 54

gas exchange

Answer 54

Diffusion - Process for the exchange of respiratory gases in the alveoli and the capillaries of the body tissues - Occurs at the alveolar capillary membrane oxygen transport - consists of the lungs and cardiovascular systems - depends on ventilation, perfusion, and rate of diffusion - hemoglobin is the key carrier for oxygen and transports 97% of the body's oxygen, decreased levels affect the body's ability to transport oxygen

Question 55

Pulmonary Circulation

Answer 55

Function is to move blood to and from the alveolar capillary membrane for gas exchange

Question 56

Lung Volume

Answer 56

- Determined by age, gender, and height - Tidal volume - Can be affected by patient’s health status and activity

Question 57

Developmental factors for oxygenation: infants

Answer 57

Premature(less than 35 weeks): - Not fully developed alveolar surfactant system - Characterized by atelectasis - Immature pulmonary circulation Term: - small airway structures makes it easy for infection to spread rapidly - obstruction -Infants and toddlers are at risk for upper respiratory tract infections as a result of frequent exposure to other children, an immature immune system, and exposure to secondhand smoke. High risk for respiratory distress -Is a collapse of the alveoli that prevents the normal exchange of oxygen and carbon dioxide

Question 58

Developmental factors for oxygenation: toddlers

Answer 58

- Upper Respiratory Infections(URI) - Airway Obstruction: Small objects being in the airway. - Drowning: Can occur in small amounts of water, never leave alone in bath tub.

Question 59

Developmental factors for oxygenation: school-age children

Answer 59

- Tonsillitis - Upper Respiratory Infections(URI) - Viral Infections: Croup and pneumonia - Asthma - School-age children and adolescents are exposed to respiratory infections and respiratory risk factors such as cigarette smoking or secondhand smoke.

Question 60

Developmental factors for oxygenation: adolescents

Answer 60

- Lifestyle choices - Vaccines - Asthma

Question 61

Developmental factors for oxygenation: adults

Answer 61

- lifestyle choices - Smoking - Lack of exercise - Young and middle-age adults are exposed to multiple cardiopulmonary risk factors: an unhealthy diet, lack of exercise, stress, over-the-counter and prescription drugs not used as intended, illegal substances, and smoking.

Question 62

Developmental factors for oxygenation: older adults

Answer 62

- Reduced lung expansion: cartilage starts to become more rigid, lungs have less recoil ability and alveoli lose elasticity - Less effective cough reflex - Declining immune response - Older adults cardiac and respiratory change with the aging process - Chest wall and airways become more rigid and less elastic - Amount of air exchanged is decreased - Mucous membranes are drier and more fragile - Decreases in muscle strength and endurance - Decrease in efficiency of the immune system - The cardiac and respiratory systems undergo changes throughout the aging process. The changes are associated with calcification of the heart valves, SA node, and costal cartilages. The arterial system develops atherosclerotic plaques. Osteoporosis leads to changes in the size and shape of the thorax. The trachea and large bronchi become enlarged from calcification of the airways. The alveoli enlarge, decreasing the surface area available for gas exchange. The number of functional cilia is reduced, causing a decrease in the effectiveness of the cough mechanism, putting the older adult at increased risk for respiratory infections

Question 63

What is the most common oxygen delivery device you will see/use?

Answer 63

Nasal Canula

Question 64

What does LPM stand for?

Answer 64

Liters Per Minute

Question 65

True or False? LPM is the same thing as percentage of oxygen.

Answer 65

False: The LPM is the flow rate not the amount of oxygen you will be giving.

Question 66

What is the normal range to set the flow meter in LPM for a regular nasal cannula?

Answer 66

1-6 Liters Per Minute

Question 67

What does FiO2 stand for?

Answer 67

Fraction of Inspired Oxygen

Question 68

What is the percentage of oxygen (or FiO2)) range for a nasal cannula?

Answer 68

25-45%

Question 69

What FiO2 is the air you are breathing right now?

Answer 69

21%

Question 70

True or False? A basic nasal cannula is a low flow device meaning that we can’t give an exact % of oxygen.

Answer 70

True

Question 71

The amount of FiO2 a patient actually receives with a low flow device fluctuates based on what?

Answer 71

Tachnypea, we cannot control how much FiO2 a patient gets by putting two prongs in their nose. Must be able to take good deep breaths for themselves.

Question 72

Nasal cannulas do NOT help with the removal of what gas?

Answer 72

Ventilation, removal of CO2

Question 73

High flow nasal cannulas can deliver PEEP (positive end expiratory pressure), what does that help to do?

Answer 73

PEEP: Positive Expiratory in Pressure, keeps the alveoli open at the end of expiration by continuing to apply pressure. Assists with ventilation, removal of CO2.

Question 74

Nugget of Knowledge

Answer 74

PEEP helps to keep the alveoli open at the end of expiration by continuing to apply pressure which helps to assist with ventilation. Remember that VENTILATION means the movement of air into and out of the alveoli and OXYGENATION is the action of oxygen diffusing passively from the alveoli to the pulmonary capillaries and then it binds to the hemoglobin in RBCs.

Question 75

What type of patient could really benefit from a high flow nasal cannula per the video?

Answer 75

COPD patients, removal of CO2 is huge.

Question 76

How many liters can a high flow nasal cannula be set at?

Answer 76

60 LPM

Question 77

What percentage of O2 can a high flow nasal cannula provide?

Answer 77

Up to 100% FiO2

Question 78

True or False? Leaving a patient on 100% FiO2 for a long period of time can cause oxygen toxicity.

Answer 78

True

Question 79

Standard or Low Flow Nasal Cannulas

Answer 79

do NOT provide humidity to the patient. Therefore, they can be very “drying” to the nasal passage which can lead to discomfort and even nose bleeds. Adding humidity (also called a “bubbler”) can help alleviate discomfort and lessen the risk of nose bleeds. Here is a 2-minute video that describes the basic idea and set up for a bubbler.

Question 80

What are three advantages of using a nasal cannula versus a mask from the patient’s perspective?

Answer 80

Nasal Cannula is already heated and humidified, keeps the patient’s nasal from drying out. Greatest advantage is the PEEP effect. Patient can eat drink, eat, and communicate.

Question 81

Patients with COPD become tolerant to high CO2 levels in their lungs, what stimulates a patient with COPD to take a breath?

Answer 81

Their drive to breath is different than a healthy patient without COPD. Get very tolerant to CO2. The hypoxic drive is what causes them to breath. (Hypoxemia) Too much oxygen knocks out their drive to breath.

Question 82

True or False? A simple face mask is most often used in a patient who could use a nasal cannula, but the patient is a “mouth breather”

Answer 82

True, the mask goes over the nose and mouth.

Question 83

What is the percentage of oxygen (or FiO2)) range for a simple mask?

Answer 83

35-60%

Question 84

How many LPM can a simple face mask be set at?

Answer 84

6-10 LPM

Question 85

Why would it be important to check the O2 saturations before putting on oxygen and again after the oxygen is on?

Answer 85

To check SPO2 on room air as well as what it is on oxygen.

Question 86

If the patient’s SpO2 is dropping on the monitor, what is the first assessment you would want to perform?

Answer 86

Check to see if the nasal cannula is even in their nose.

Question 87

True or False? It is important to perform a skin assessment around the nares, back of the ears, cheeks and any place where the device is in contact with the skin, at least once a shift if the patient is wearing any type of oxygen device (nasal cannula, mask, trach collar, etc..)

Answer 87

True

Question 88

True or False? It is incredibly important to actually count the respiratory rate of a patient who is having respiratory issues and not just guess a number between 12-20.

Answer 88

True, do not guess the number

Question 89

When administering a nebulizer, it is important to do what task first before turning on the oxygen?

Answer 89

Put the medication in the chamber

Question 90

What are you looking for to know that you have enough liters of oxygen flowing for a nebulizer treatment?

Answer 90

Look for mist

Question 91

When you enter a room where a patient is using oxygen, what assessments should be made?

Answer 91

Always make sure that you are checking to see the nasal canula is actually on. Check for edema and do a skin assessment.

Question 92

The two different types of flow meters behind the patients bed

Answer 92

One is for oxygen and one is for medical air. The medical air can be used to give a nebulizer treatment for a patient who doesn’t need supplemental oxygen. Medical air is the same FiO2 as room air (21%) and cannot be used with an oxygen device (nasal cannula, mask, etc…) because it is no different than breathing room air. Look at the label on the wall—green is oxygen, yellow is medical air

Question 93

Documentation of End-of-Life Care

Answer 93

- Time and date of death and actions taken to respond to the impending death. - Name of health care provider certifying the death. - People notified of the death and person who comes to declare time of death. - Name of person making request for organ or tissue donation. - Special preparations of the body. - Medical tubes, devices, or lines left in or on the body. - Personal articles left on and secured to the body. - Personal items given to the family with description, date, time, to whom given. - Location of body identification tags - Time of body transfer and destination - Any other relevant information or family requests that help clarify special circumstances. - Verify with health care agency.

Question 94

Types of Loss

Answer 94

- Loss of possessions or objects: Extent of grieving depends on value of object, sentiment attached to it, or its usefulness. - Loss of known environment: Loss occurs through maturational or situational events or by injury/illness. Loneliness in an unfamiliar setting threatens self-esteem, hopefulness, or belonging. - Loss of significant other: Close friends, family members, and pets fulfill psychological, safety, love, belonging, and self-esteem needs. - Loss of an aspect of self: Illness, injury, or developmental changes result in loss of a valued aspect of self, altering personal identity, and self concept. - Loss of life: Loss of life grieves those left behind. Dying people also feel sadness or fear pain, loss of control, and dependency on others.

Question 95

Normal Symptoms of Grief

Answer 95

Feelings: Sorrow, fear, anger, guilt or self-reproach, anxiety, loneliness, fatigue, helplessness/hopelessness. Cognitions: Disbelief, confusion or memory problems, Inability to concentrate Physical Sensations: Headaches, Nausea and appetite disturbances, Tightness in the chest and throat, insomnia, Oversensitivity to noise, muscle weakness, lack of energy, dry mouth. Behaviors: Crying, distancing from people, absentmindedness, dreams of the deceased.

Question 96

Factors Influencing Oxygenation

Answer 96

``` Physiological Developmental Lifestyle Environment Medications ```

Question 97

Psychological Factors Influencing Oxygenation

Answer 97

-Decreased oxygen-carrying capacity -Hypovolemia -Decreased inspired oxygen concentration Increased metabolic rate -Conditions affecting chest wall movement: Pregnancy, obesity, neuromuscular disease, musculoskeletal abnormalities, trauma, neuromuscular disease, CNS alterations -Chronic diseases

Question 98

Environmental Factors Influencing Oxygenation

Answer 98

-Location: Altitude, heat, cold, air pollution(smog, second hand smoke), allergies -Workplace: Asbestos, talcum powder, dust, airborne fibers -The environment influences oxygenation. The incidence of pulmonary disease is higher in smoggy, urban areas than in rural areas. Occupational pollutants include asbestos, talcum powder, dust, and airborne fibers.

Question 99

Lifestyle Factors Influencing Oxygenation

Answer 99

-Nutrition: obesity decreases lung expansion, malnourished experiences muscle wasting, high fat and salt intake increase risk for heart disease and inadequate diet can lead to anemia -Exercise: increases the metabolic activity and oxygen demand of the body, daily exercise lowers pulse rate, BP, cholesterol, increases blood flow and greater oxygen extraction, in contrast a sedentary lifestyle lack alveolar expansion and deep breathing patterns and are less able to respond effectively to respiratory stressors -Smoking: including second hand are associated with heart disease, COPD, lung CA(10 times greater smoker vs non) -Substance abuse: alcohol and drugs impair oxygenation by depressing respiratory center, reducing rate and depth Stress-continuous stress increases oxygen demand on the body, body responds with an increased rate and depth of respiration, psychological and physiologic responses to stress can affect oxygenation, hyperventilation is response to stress-light headedness, numbness and tingling of fingers, toes, and around the mouth -Pregnancy

Question 100

Unsafe herbs

Answer 100

- Calamus - Chaparral - Coltsfoot - Comfrey - Ephedra - Life root - Pokeweed - Caster Plant (most poisonous) - Poison Ivy (least harmful) - fox glove - belladonna - doll's eye

Question 101

National Center for Complementary and Integrative Health

Answer 101

- “We conduct and support research and provide information about complementary health products and practices." - “If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.” - If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.” - There are many definitions of “integrative” health care, but all involve bringing conventional and complementary approaches together in a coordinated way.

Question 102

10 most common complementary health approaches among adults

Answer 102

- natural products - deep breathing - Yoga, Tai Chi, or Qi Gong - Chiropractic or Osteopathic Manipulation - meditation - message - special diets - homeopathy - progressive relaxation - guided imagery

Question 103

If we don't eliminate waste what will happen?

Answer 103

We will become toxic, things build up in the system and we will have pain and dysfunction. We have to eliminate waste or we will die.

Question 104

Factors affecting bowel elimination

Answer 104

- Age - Diet - Fluid intake - Physical activity - Psychological factors - Personal habits/cultural factors - Position during defecation - Pain - Pregnancy - Surgery and anesthesia - Medications - Diagnostic Tests

Question 105

Bowel Elimination Assessment: Nursing History

Answer 105

- Usual elimination pattern-time of day-frequency - Patients description of usual stool characteristics - Identification of routines that promote elimination - History of any bowel surgeries or diversions - Family history-GI cancer or other GI issues - Changes in appetite - Diet history-special diets - Fluid intake - Medication history - During the history: Ask about any pain or discomfort when passing the stool and then look at the rectum to see if there is a physical cause for this.

Question 106

What are the parts of the GI system that we can see and directly assess?

Answer 106

The mouth, abdomen, the rectum, and the stool that comes out.

Question 107

Common Bowel Elimination Problems

Answer 107

- Constipation/obstipation: Severe constipation is obstipation, the stool has become so impacted and compacted together you aren’t able to pass it out of the rectum. - Impaction: Obstipation can lead to an impaction. - Diarrhea: Common in places where the water has parasites in it. - Incontinence: Not being able to hold the bowel content in. - Flatulence: It can be a problem is someone is very gassy. - HemorrhoidsVaricose veins of the rectum.

Question 108

Common Causes of Constipation

Answer 108

- Irregular bowel habits and ignoring the urge to defecate. - Chronic illnesses (Parkinson's, multiple sclerosis, RA, bowel disease, depression, eating disorders.) - Low-fiber diet high in animal fats. - Low fluid intake - Stress - Physical inactivity - Medications, especially opiates. - Changes in life of routine such as pregnancy, agin, and travel. - Neurological conditions that block nerve impulses to the colon. (Stroke, spinal cord injury, tumor) - Chronic bowel dysfunction. (colonic inertia, irritable bowel)

Question 109

Signs of dehydration in adults

Answer 109

Thirst, less frequent urination than usual, dark-colored urine, dry skin, fatigue, dizziness, light-headedness

Question 110

Signs of dehydration in infants and children

Answer 110

Dry mouth and tongue, no tears when crying, no wet diapers for 3 or more hours, sunken eyes or cheeks or soft spot in the skull, listlessness or irritability.

Question 111

Constipation

Answer 111

-A decrease in the frequency of bowel movements or a difficulty in passing stool. Usually less than three a week. -Difficulty in starting or completing a bowel movement -Infrequent and difficult passage of stool -Passing hard stool after prolonged straining -SYMPTOMS: Abdominal pain/bloating Excess of /or inability to pass gas Nausea/loss of appetite/headache -It is a symptom of another problem. It could be a symptom of something serious such as an anal fissure, bowel cancer or a bowel obstruction. Problems and diseases such as Parkinson’s disease, multiple sclerosis, spinal cord injuries or stroke can cause chronic constipation. Any problem that can interfere with the muscles of the rectum. -Chronic constipation with straining can lead to an increased risk of hemorrhoids (varicose veins of the rectum) , rectal fissures (tears in the rectum), rectal prolapse or fecal impaction. -Laxatives, suppositories and enemas can be used but we don’t want people to become dependent upon them unless treatment of the problem requires it.

Question 112

Diarrhea

Answer 112

- 3 or more loose/liquid stools per day - Fluid and nutrients aren’t absorbed - Can lead to dehydration and electrolyte or acid-base imbalances. - Infants, children and older adults are particularly susceptible to the effects of diarrhea - Diarrhea could be a symptom of another problem such as infection or infestation. - Frequent stools can also lead to skin breakdown. Be sure to clean gently after each diarrhea stool and apply moisture barrier or protective creams or ointments. - Patients also have complaints of weakness, lethargy, bloating, gas and loss of appetite.

Question 113

Reiki and other Energy therapies

Answer 113

- Manipulation of “human energy fields”. - Developed in the 1970s - Redirects “energy” to remove obstructions to “harmonize” the body. - No scientific evidence that there is a human energy field - But human touch and someone caring for you in important - Placebo effect

Question 114

Bowel training or habit training

Answer 114

- Establishing a daily routine for patients with chronic constipation or fecal incontinence - Requires time, patience and consistency - Providing the opportunity to defecate at the same time each day - Pt’s with spinal cord damage may need a routine of suppository’s, rectal stimulation, or May need habit training.

Question 115

Bowel Retraining for Older Adults

Answer 115

- Older adults more at risk for constipation - Increase fiber in diet with whole grains, legumes, fruits, and vegetables. - Minimum of 1500mL of fluid per day. - May need a lighter plastic cup filled half full if holding a drink is an issue. - Encourage regular exercise - Pt's need to feel at ease during elimination - Review meds with provider to substitute meds that will not cause constipation. - Behavioral interventions such as time toileting helps.

Question 116

A successful bowel training program includes

Answer 116

- Assessing normal elimination and recording when patient is incontinent. - Incorporating gerontological nursing for older adults - Choosing a time based on pt's normal pattern. - Offering a hot drink or fruit juice to stimulate a bowel movement - Help patient toilet at designated time - Provide privacy - Instruct patient to lean forward at the hips while sitting on the toilet - An unhurried environment and nonjudgemental - Maintain normal exercise

Question 117

Bedpans

Answer 117

- Most unnatural thing to do to try and have a bowel movement on a bedpan. - If pt is unable to get out of bed due to disease or other problems or about to have a bowel movement, but if they stood up they would be incontinent, we would use a bedpan. - Fracture pan: Much more shallow meant to slide under the patient. Patient’s who have a hip fracture, this doesn’t hold much, you will almost always have some spillage. Really important to put some sort of pad under the patient so you don’t have to change the entire bed. 0Do not leave patients on this for a long time, especially patients that aren’t cognitive. They may get breakdown if they are on it to long.

Question 118

med terms for urinary alterations

Answer 118

``` Urgency Dysuria Frequency Hesitancy Polyuria Retention Oliguria Nocturia Dribbling Hematuria Residual urine ```

Question 119

Bedpan tips

Answer 119

- Lower head of bed when positioning - Don’t push pan under buttocks - Raise head of bed to position of comfort when patient is attempting to use bedpan - If patient left alone to attempt use, place call light within -reach - Lower head of bed before removing - Watch out for pressure ulcers - Assist with cleaning the patient if necessary

Question 120

nursing process assessment for urinary system

Answer 120

Self-care ability: - Can the patient do this? - Be professional and appropriate - Talk about expectations and what they can do for themselves - Encourage them to do the most they can for themselves Health literacy: - Do they understand how this works?

Question 121

Assessment of Stool

Answer 121

Color: -Infant: Yellow -Adult: Brown Odor: Sometimes it has a unique odor to it. The odor of blood has a very distinct scent. Sometimes it smells grassy. Want to be able to describe that. Consistency: Soft, formed, runny Frequency: -Infant: 4-6 (breastfed), 1-3(bottle-fed) -Adult: Twice daily to 3 times a week. -Shape: Pebbles, logs, resembles diameter of rectum. -Constituents: The things we seen in the stool. Sometimes the capsule does not dissolve all the way. Seedy. Anything identifiable within the stool. If you give a capsule and the capsule comes out, they absorbed the contents, but not the capsule. Seed and corn are things that can be seen. Anything identifiable in the stool. -Rotavirus: most common causes of diarrhea in infant and children.

Question 122

Stool Colors

Answer 122

- Brown: Normal - Green: Food may be moving through large intestine too quickly or you ate a lot of veggies. - Yellow: Greasy, foul-smelling yellow poop indicates excess fat, which could be due to a malabsorption disorder like celiac disease - Black: Upper GI bleeding that could be an ulcer or cancer. - Clay-colored: Could mean a bile duct obstruction - Blood-stained: Bleeding lower in the GI tract, cancer, trauma, surgery. This blood hasn’t had a chance to be digested. We need to keep an eye on this and report to the provider. Keep an eye on the vascular status and make sure they don’t have decreasing blood pressure.

Question 123

Why do people use complementary health?

Answer 123

- Slow to get a definitive diagnosis ( especially with hormonal and autoimmune disorders- can take 2-3 years to get a diagnosis) - Treatments don’t seem to help/cure the problem - Experiencing adverse effects of treatments - Misadventures or frustrations during surgical or medical care - Procedures can cause abnormal reactions or complications - Frustrations with the cost of the medical system and insurance companies

Question 124

3 rules of thumb for incorporating alternative therapies into cancer care

Answer 124

1. the therapy should not cost an exorbitant amount of money. Sad to say, there are charlatans out there who take advantage of the vulnerable. If they can squeeze additional money out of those who are desperate, they will. It should not cost an arm and a leg. 2. it should not hurt. It should not have so many side effects or be so uncomfortable that it reduces quality of life, causes pain, or whatever it might be. Coffee enemas, for example, are unproven, uncomfortable, and no good. 3. the therapy should not get in the way of the other, conventional therapies. That is a consideration because some herbal remedies may inhibit certain enzymes involved in the metabolism of our drugs. There also may be the possibility of other interactions.

Question 125

Who can practice complementary therapies?

Answer 125

- There is no standardized national system for credentialing complementary health practitioners. State governments are responsible for deciding what credentials practitioners must have to work in that state. - The credentials required for complementary health practitioners vary widely from state to state and from discipline to discipline.  - Missouri has boards that regulate acupunctures, cosmetology, barbers, massage, and nursing - in Kansas you have to go to Kansas board of healing arts website and look into each type of practitioner. They do not currently have regulations for acupuncture, naturopathy, and massage therapists - It is up to client to do the research

Question 126

Herbal Supplements

Answer 126

- They are not approved for use as drugs and are not regulated by the FDA. - People with chronic diseases are more likely to use herbal medicines than others (cancer, stroke, or arthritis) - Health care providers need to know all of the supplements and other medications a patient is taking. - We need to know because of toxicities and interactions. - Sales on supplements is an $8 billion a year industry - They can suggest what they are used for but cannot make any medical claims - Placebo affect - Sometimes contaminated with herbs, heavy metals, and contaminates (fillers) - Strength of chemical can vary in the plant (not consistent) - Lack studies

Question 127

factors with herbal supplement use

Answer 127

Age > 70 Having a higher than high school education Taking prescription medications (40% of people who use herbal use OTC and prescription drugs too) Using mail in pharmacies

Question 128

Chiropractic therapy

Answer 128

- A spinal manipulation therapy that treats, “a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health.” - Certain chiropractic services such as spine manipulation are covered by Medicare and Medicaid for all adults in the United States.[5] Also, chiropractic care is one of the health benefits included in the workers' compensation systems in most US States. - Referrals between physicians and chiropractors - Standardized regulations - Different styles, as of 2016 there was not a study to show which is better - Good evidence that spinal manipulation therapy or chiropractic is good for people with lower black pain, but not superior to other treatments - Helps with neck pain and headaches - Used by physical therapists, doctors of osteopathy - Some report Short-term AEs from manipulations- increased vocal pain, stiffness - Others say they had immediate relief - Massage therapists, and acupuncture in these offices - May promote a certain brand or kinds of herbal supplements in their office

Question 129

relaxation therapies

Answer 129

- biofeedback- uses electronic device to send back info with colored screen about pulse rate, muscle tension or other body function. Give tone or visual cue, by altering the screen you can create a relaxed state - Meditation- - Guided imagery- person talks you through a situation that is relaxing, brings up pleasant memory. Be careful in patients with PTSD (may need training for this) - Progressive relaxation- start with muscles in head and work your way through body and go through each muscle system. - Effectively lower BP and HR, decrease muscle tension, improve wellbeing, reduce symptom destress - Help mitigate the AEs and the natural stress of the inflammatory process, placebo effect is part of it

Question 130

Massage

Answer 130

- Massage can help people relax, relieve aching muscles, and temporarily lift a person's mood. - Increase endorphin release - Cannot massage on legs in patients in hospital (can release blood clots) - Human touch is very important for people - Can increase wellbeing - Decrease depression - Must be licensed to do this - Must know patients allergies (oils) - Do they have any health problems? - Do they have a hx of blood clots?

Question 131

Nursing Diagnosis/Analysis (for urinary)

Answer 131

- Functional urinary - incontinence - Stress urinary incontinence - Urge urinary incontinence - Risk for infection - Toileting self-care deficit - Impaired skin integrity - Impaired urinary elimination - Urinary retention

Question 132

Tai Chi

Answer 132

- Found to more useful in treating fibromyalgia than aerobic exercise - Helps decrease anxiety - Improves cognition and decreased falls in the elderly - Slow movements - Helpful in elderly for muscle strength and balance, improves cognition (decreased falls)

Question 133

Acupuncture

Answer 133

- Manipulation of the flow of chi through meridians by inserting needles at certain point. - Must be sure practitioner uses sterilized needles for therapy, but I most do not clean the site before inserting the needle. - Chinese and Japanese medicine - They consider human body to have a flow of energy that rises to the surface at different points and these points can be manipulated - Classify things in body as: Hot, dry, cold, or wet - Diagnose by feeling pulses and looking at the tongue (helps determine where to put needles and where to manipulate energy) - Prof Kirkland thinks it works

Question 134

Moxibustion and cupping

Answer 134

- Moxibustion is the burning of mugwort over acupoints. Burns are the most frequently-reported complication or infection (cellulitis), can contract other infections - Same concept of moving chi as with acupuncture/acupressure. - Also used with the concept of “purification of toxins”. - Create a vacuum by putting heated air into it and attaching it to the skin - Supposably Moves chi and release toxins, but normally kidney or liver gets rid of toxins - If allergic to ragweed may have problems with mugwort because mugwort is related to dandelion (hay fever reactions) - Mugwort used to be used in beer before they discovered hops

Question 135

Candling

Answer 135

- also known as auricular candling or coning, refers to various procedures that involve placing a cone-shaped device in the ear canal and supposedly extracting earwax and other impurities with the help of smoke or a burning wick. - Can buy these in stores - Basically its candle wax that is seen - It does not produce a vacuum- if it did then it would rupture ear drum - Cannot convince practitioner or recipient that this isnt good - Biggest AE- burns or obstruction

Question 136

Naturopthay/Homeopathy

Answer 136

- The Food and Drug Administration on Monday proposed a tougher enforcement policy toward homeopathic drugs, saying it would target products posing the greatest safety risks, including those containing potentially harmful ingredients or being marketed for cancer, heart disease and opioid and alcohol addictions. - Homeopathy is based on an 18th-century idea that substances that cause disease symptoms can, in very small doses, cure the same symptoms. Modern medicine, backed up by numerous studies, has disproved the central tenets of homeopathy and shown that the products are worthless at best and harmful at worst. - Can go to store and get this as well - Tinctures that they sell are based on the theory that a small amount of something triggers a big reaction in the body

Question 137

med terms for urinary alterations

Answer 137

``` Urgency Dysuria Frequency Hesitancy Polyuria Retention Oliguria Nocturia Dribbling Hematuria Residual urine 46-2 (will put these in soon) ```

Question 138

process of urination

Answer 138

- Kidneys - Ureters - Bladder - Urethra - Nephron

Question 139

nursing process assessment for urinary system

Answer 139

Self-care ability: - Can the patient do this? - Be professional and appropriate - Talk about expectations and what they can do for themselves - Encourage them to do the most they can for themselves Health literacy: - Do they understand how this works?

Question 140

Assessment history questions for urination

Answer 140

``` What is the nature of the problem? What are the signs and symptoms? What is the onset and duration? What is the severity? Are there any predisposing factors? How has this impacted you? ```

Question 141

Assessment of urine

Answer 141

Intake and output (amount): - Normal output- 1200-1500mL - Look for an hourly output less than 30 mL for more than 2 consecutive hours- concern Clarity: - send to lab right away if cloudy - if cloudy on its own- bacteria, WBC, or first morning pee - Normal color- straw colored, pale, amber - Different meds can make it different colors- Amitriptyline can make it green Blood impacts color - Most concentrated urine is in the AM or when dehydrated Odor: - stagnate- ammonia, fowl- infection, food can indicate the smell too (garlic, asparagus) - The more concentrated it is, the stronger the odor

Question 142

factors influencing urination

Answer 142

- Anything that can block blood flow to kidneys or impact the urinary tract - Disease conditions: Diabetes, stroke, spinal cord injury, prostate enlargement - Psychological factors(including personal habits): Anxiety, lack of time to go to the bathroom, privacy, dignity - Diet: Caffeine, alcohol (increased urine), sodium (water retention and decreased urine production) - Surgical procedures: Childbirth, anesthesia Medications: Medications either increase urinary retention (diuretics) or slow retention, Sedatives can make it difficult for them to know when they need to go Pain: If having pain they may not want them to get up

Question 143

Pediatrics- urinary

Answer 143

- Can control voluntary voiding at 18-24 months - Readiness for toilet training: - Recognize bladder fullness - Hold urine for 1-2 hours - Communicate sense of urgency - Wont have full control until 4 or 5 - Weigh diapers to weigh I&O

Question 144

pediatric elimination

Answer 144

- Accurate Intake and Output - Average urine production: - Newborn:10 mL/hr - Infant:5-10 mL/hr (get introduced to solid foods) - Toddler: 15-20 mL/hr - School-age: 10-25 mL/hr - Adolescent: greater than 30 mL/hr

Question 145

older adult elimination

Answer 145

- Decrease in bladder capacity and muscle tone - Ability to hold urine decreases - Increased risk for incontinence because of chronic Illness - Inefficient emptying of the bladder - Men-enlarged prostate after 40

Question 146

sociocultural aspects of care for urinary

Answer 146

- Culture and gender norms vary - Social expectations - Women sit, Men stand - Try to accommodate them - Some more comfortable having their family assist them - Schedules have an impact on urination

Question 147

urinary retention

Answer 147

- accumulation of urine resulting from the inability to empty the bladder completely (obstruction, inflammation, swelling, neurological problems, meds, anxiety) - They state they are experiencing fullness, tenderness of symphysis pubis, restless, diaphoretic - Stretching of the bladder - Post void residual

Question 148

Urinary Tract Infection

Answer 148

One of the most common infections Characterized by location and signs and symptoms of infection Upper UTI- infection of the bladder (typically need antibiotics) Lower UTI- burning or pain with urination, irritation (urgency, frequency, fowl smelling urine) CAUTIs- catheter associated UTI- make sure you insert catheter safely and provide catheter care (we can prevent this) - UTIs can cause mental status change

Question 149

Types of Incontinence

Answer 149

- lack of voluntary control of urination - Assoc w/ causing skin issues, problems with mobility, can lead to having skin breakdown, depression Stress Incontinence: due to increased abdominal pressure under stress (weak pelvic floor muscles), small volumes leaked, d/t trauma, childbirth, when you cough or sense Urge Incontinence: due to involuntary control of urination, passage of urine with a strong urgency (may leak on the way to the bathroom) Overflow Incontinence: due blockage of the urethra, over distended bladder, having weak bladder contractions Neurogenic Incontinence: due to impaired functioning of the nervous system, not getting correct messages

Question 150

Nursing Diagnosis/Analysis

Answer 150

- Functional urinary - incontinence - Stress urinary incontinence - Urge urinary incontinence - Risk for infection - Toileting self-care deficit - Impaired skin integrity - Impaired urinary elimination - Urinary retention

Question 151

Planning (for urinary)

Answer 151

- Goals & outcomes: set realistic and individualized goal, collaborate w/ the pt - Setting priorities: patient's immediate physical and safety needs, patients expectations and readiness to perform some self-care activities - teamwork & collaboration: occupational and physical therapies, family

Question 152

Implementation promoting normal urination

Answer 152

- education: make sure it is on their level - keep good voiding habits - integrate patients' elimination habits into nursing care - maintain adequate fluid intake - promote complete bladder emptying - prevent infection - acidifying urine - stop smoking - Good cleaning habits - Voiding after intercourse - Promote healthy lifestyles

Question 153

Interventions to reduce UTIs

Answer 153

- Good hand hygiene when toileting - Urinate when have urge - Adequate fluid intake - Avoid catheterization when possible - Sterile technique (asepsis) with catheterization - Ensure catheter is draining appropriately - Gender considerations

Question 154

interventions for incontinence

Answer 154

- Adequate lighting - Mobility aides: Toilet rise- makes it higher and easier to get down, Bedside commode, Walker - Briefs: Change patients brief to keep them dry - Intermittent catheterization: May need 1 or 2 catheterization to wake the bladder up - Avoiding irritants - Pelvic muscle exercises - Toileting schedule

Question 155

Urine tests

Answer 155

- Urine culture and sensitivity: sterile or clean voided sterile, 24-48 hours to see bacterial growth, this will help to see what antibiotics to give the patient - 24 hour urine collection: collection- usually for renal disorders to evaluate problems - Urinalysis: UA, most common, screening and aid to help diagnose renal, hepatic and other diseases (strips) - Blood urea nitrogen level(BUN): extent of renal clearance, urea nitrogenous waster, overall renal function - Serum creatinine level: measures amount of creatinine in urine - KUB(kidney, ureters, and bladder) radiography: Xray of the urinary system and adjacent structures to detect urinary calculi - Bladder ultrasonography: Non-invasive method for measuring the volume of urine in the bladder - Computed tomorgraphy(CT) and Magnetic resonance imaging(MRI): Provide cross sectional views of the kidney and urinary tract - specific gravity: gauges ability of kidneys to affectively concentrate urine

Question 156

Hemoccult: Occult Blood Testing

Answer 156

Equipment: Test paper, hemoccult developer, wooden applicator, and clean gloves. Steps: 1. Identify patient using two identifiers. 2. Explain purpose of test and ways patient can help. Patient can collect own specimen if possible. 3. Perform hand hygiene and apply clean gloves 4. Use tip of wooden applicator to obtain a small part of stool specimen. Be sure that specimen is free of toilet paper and not contaminated with urine. 5. Open flap of slide and smear stool in first box. Smear different part of stool in second bod. 6. Close slide and turn it over apply 2 drops of solution to each box. Blue color means positive. Interpret color after 30-60 seconds. 7. AFter determining if patient is positive or negative add 1 drop of solution to the control section and interpret within 10 seconds. -Occult blood-hidden blood

Question 157

Hemoccult Instructions

Answer 157

- Before taking sample: Avoid NSAIDS for 7 days if possible. Avoid citrus fruits and juices or doses of Vit. C and red meat for 3 days before obtaining sample. - Put a label on the specimen card. - Place a sample on Box A and a sample from a different area in Box B. - Close flap and set timer for 3-5 minutes. - Open back flap and add 2 drops of developer on each area-wait 60 seconds to read results.

Question 158

Laboratory and Diagnostic Tests

Answer 158

- Fecal Specimens - Endoscopy - Ultrasound - Colonoscopy - Barium Enema/Swallow - CT - MRI

Question 159

Testing

Answer 159

-ABDOMINAL SONOGRAM: -Non-invasive -Can be done quickly at the bedside. -No preparation needed -PARACENTESIS: done in specialty lab or in patients room Attain informed consent -Needle or catheter is inserted into the abdomen to collect and/or drain fluid. -CT SCAN: -Can be done with and without contrast -MRI-magnetic resonance imaging -Pre-test checklist must be filled out -If dye is injected then they have to have informed consent -NPO -Checklist to make sure they have no metal

Question 160

Interventions for elimination alterations

Answer 160

- Cathartics and Laxatives - Anti diarrheal agents - Enemas - Digital Removal: removal of impaction with finger - If laxative doesn’t work then can try suppository - Children in the potty training- having a bowel movement is like losing part of self - Do not use adult laxatives

Question 161

Why is sleep so important?

Answer 161

- Provides healing and restoration - Promotion of good health and recovery from illness - Sick require more sleep and rest than healthy

Question 162

Sleep

Answer 162

- Cyclical physiological process that alternates with longer periods of wakefulness - Sleep wake cycle influences and regulates physiological function and behavioral responses

Question 163

Rest

Answer 163

-State of mental, physical and spiritual activity that leaves person feeling refreshed and rejuvenated

Question 164

Sleep and Rest

Answer 164

-Rest contributes to: Mental relaxation Freedom from anxiety State of mental, physical, and spiritual activity -Bed rest does not guarantee that a patient will feel rested.

Question 165

Circadian Rhythm

Answer 165

-24 hour day/night cycle -Controlled by nerve cells in the hypothalamus -Influences body temperature, heart rate, blood pressure, hormone secretion, sensory acuity, and mood -Affected by light, temperature, social activities, and work routine -Acute Care: Typical hospital routines

Question 166

Sleep Regulation

Answer 166

- Controlled by the CNS - Major center is the hypothalamus - RAS(reticular activating system) contains cells that maintain alertness and wakefulness - BSR(bulbar synchronizing region) contains cells that release serotonin to evoke sleep

Question 167

Sleep Cycle

Answer 167

``` -Nonrapid Eye Movement(NREM) Stage 1 Stage 2 Stage 3 Stage 4 -Rapid Eye Movement(REM) ```

Question 168

How patients move through the sleep cycle

Answer 168

- Presleep sleepiness-> NREM Stage 1 ---> NREM Stage 2 ----> NREM Stage 3 -----> NREM Stage 4 ----> NREM Stage 3----> NREM Stage 2 ----> REM Sleep ----> NREM Stage 2 ----> - Most people will pass through 4-5 sleep cycles each night. Usually last 90-100 minutes. Depends on how long you are sleeping.

Question 169

Functions of Sleep

Answer 169

- Physiological and psychological restoration - NREM-contributes to body tissue restoration, GH released - Body conserves energy - REM-brain tissue and cognitive restoration - Dreams assist in learning, memory processing and adaptation to stress  - Dreams occur during REM sleep

Question 170

Stage 1

Answer 170

- Lightest level of sleep - Lasts a few minutes - Begins with a gradual fall in vital signs - Sensory stimuli easily arouses person - If awakened person feels as though daydreaming occurred

Question 171

Stage 2

Answer 171

- Period of sound sleep - Relaxation progresses - Still easily aroused - Lasts 10-20 minutes - Continued slowing of body function

Question 172

Stage 3

Answer 172

- Initial stages of deep sleep - Difficult to arouse and rarely moves - Muscles are relaxed - Vital signs decline but are still regular - Lasts 15-30 minutes

Question 173

Stage 4

Answer 173

- Deepest stage of sleep - Very difficult to arouse - Vital signs are significantly lower - Sleep walking and enuresis can occur - Lasts 15-30 minutes

Question 174

REM Sleep

Answer 174

- Vivid, full color dreaming - Begins 90 minutes after sleep has begun - Rapidly moving eyes, fluctuating heart and respiratory rates, and increased or fluctuating heart rates - Loss of skeletal muscle tone - Gastric secretions increase - Very difficult to arouse - Duration of REM sleep increases with each cycle and averages 20 minutes - The length of time we sleep in this cycle will all depend on how many cycles we make it through.

Question 175

Infant Considerations for Sleep

Answer 175

- Usually develop a nighttime pattern of sleep by 3 months - Several daytime naps - 8-10 hours a night - Total around 15 hours a day

Question 176

Pediatric Considerations for Sleep

Answer 176

``` -Toddlers: Age 2 sleeping through the night and daily naps Average 12 hours total -Preschoolers: Average 12 hours a night Rarely naps -School Age: Averages 10-12 hours -Adolescents: Average 7.5 hours a night ```

Question 177

Adult Considerations for Sleep

Answer 177

``` -Young adults Average 6-8.5 hours -Middle Aged adults Total amount of time sleeping decreases Insomnia common Stage 4 sleep decreases ```

Question 178

Geriatric Considerations for Sleep

Answer 178

- Progressive decrease in stages 3 and 4 - Some will have almost no stage 4 sleep - Awaken more at night - Higher tendency to nap during the day - Presence of chronic illness can result in sleep disturbances

Question 179

Factors Influencing Sleep

Answer 179

-Drugs and substances: Hypnotics, diuretics, narcotics, antidepressants, alcohol, caffeine, beta-blockers, anticonvulsants -Lifestyle: Work schedule, social activities, routines -Usual sleep patterns: May be disrupted by social activity or work schedule -Emotional stress: Worries, physical health, death, losses -Environment: Noise, routines -Exercise and fatigue: Moderate exercise and fatigue cause a restful sleep -Food and calorie intake: Time of day, caffeine, nicotine, alcohol -Diuretic right before bed impacts the sleep if they are having to get up and go to the bathroom throughout the night. -Knowing the list of medications our patients are on can be very important -Assessment questions collect data to help our patients sleep.

Question 180

Physical Illness

Answer 180

``` -Illnesses that cause pain, physical discomfort, mood problems(anxiety/depression)can lead to sleep disturbances: Hypertension Respiratory disorders Nocturia Restless leg syndrome (RLS) Peptic Ulcers ```

Question 181

Signs and Symptoms of Sleep Deprivation

Answer 181

``` -Physiological symptoms: Blurred vision Fine motor problems Decreased reflexes Slowed response time Decreased reasoning and judgement Decreased auditory and visual alertness Cardiac arrhythmias -Psychological Symptoms Confused and disoriented Increased sensitivity to pain Irritable, withdrawn, apathetic Agitated Hyperactive Decreased motivation Excessive sleepiness Suspicious ```

Question 182

Sleep Disorders

Answer 182

-Insomnias Poor sleep hygiene, adjustment sleep disorder -Hypersomnia Narcolepsy -Parasomnias Sleep walking, sleep terrors, nightmares, hallucinations, bedwetting(enuresis) -Sleep Apnea Excessive Daytime Sleepiness -Behavioral Sleep disorders Jet lag, shift work, drug or substance use

Question 183

SIDS(sudden infant death syndrome) risk Reduction

Answer 183

-Teach “Back to Sleep”: always place infants on their backs to rest/sleep -Educate prior to discharge

Question 184

Tests to Measure SleepSleep Studies

Answer 184

- Polysomnogram(PSG)-EEG, EMG, and EOG-monitor stages of sleep and wakefulness - Multiple Sleep Latency Test(MSLT)-measures eye movements, muscle tone and brain electrical activity. Measured during the day during napping periods.

Question 185

AssessmentSleep History

Answer 185

- Physical and psychological illness - Current life events - Emotion and mental status - Bedtime routines - Bedtime environment - Behaviors of sleep deprivation - Revisit factors that can impact sleep and ask good open-ended questions to determine what is causing problems with sleep.

Question 186

Nursing Process- Assessment of Sleep

Answer 186

- Determine the patients current sleep pattern. - Review factors affecting patient's sleep - Assess the patient's response to sleep disturbance - Sleep is subjective - Assess the patients developmental level - Explore the patient's approaches to improve sleep in the home - Aim assessment at understanding the characteristics of the patient's sleep problem and usual sleep habits to incorporate this into the nursing plan.

Question 187

Pediatric Sleep Assessment

Answer 187

- Seek information from parents as they are a reliable source - Hunger, excessive warmth, separation anxiety, excessive stimulation affect sleep

Question 188

Nursing Process-Diagnosis and Analysis

Answer 188

- Review assessment and look for clusters of data that might indicate sleep disturbances - Anxiety - Ineffective breathing patterns - Acute confusion - Compromised family coping - Insomnia - Fatigue - Sleep deprivation

Question 189

Nursing Process-Planning

Answer 189

- Select nursing interventions that will promote sleep in the home/healthcare setting - Involve sleep partner as needed in the selection of interventions - Individualize sleep therapies to the patient’s preferences - Sets individualized and realistic goals

Question 190

Nursing Process-Implementation

Answer 190

-Largely focused on health promotion: Develop behaviors conducive to rest and relaxation -Carrying out interventions to enhance and promote normal sleep patterns: Creating good sleep hygiene Promoting bedtime routine Reducing stimuli Promoting safety, comfort, and stress reduction Pharmacologic approach

Question 191

Nursing Process-Evaluation

Answer 191

- Patient is the best source for evaluating outcomes - Evaluate signs and symptoms of the patient’s sleep disturbance - Review the patient’s sleep pattern - Ask the patient’s sleep partner to report the patient’s response to sleep therapies - Ask the patient if the expectations of care are being met

Question 192

Sleep Disruptions in Acute Care

Answer 192

-Patients vulnerable to sleep problems related to: Frequent monitoring and care Lights Other patients Care givers Equipment induced noises(alarms, call lights, telephones) Room temperature -Noises cause increased agitation, delayed healing, impaired immune function, increased blood pressure, heart rate and stress

Question 193

Considerations for Acute Care

Answer 193

- Promote Comfort: Keep beds clean and dry, good positioning for pt, warm shower or warm washcloth before bed. - Establish periods of rest and sleep: Avoid activities during the night, be queit when entering a pt’s room. Cluster care and get two different things close together like meds and VS. - Promoting Safety: Make sure they are safe, do they know how to call nurse and call light in reach - Stress Reduction: Any control we can give to patient can help ease anxiety, educate the patient. - Physiological Disturbances: Things we can help control pain, nausea, monitor and control physical symptoms.

Question 194

Control of Noise in Acute Care Setting

Answer 194

- Control the Environment: - Close patient’s door when possible - Reduce volume on phones - Turns off tv unless patient requests it on(reduce volume) - Avoid loud noises(moving beds, other equipment) - Keep conversations quiet - Cluster nursing care

Question 195

Colonoscopy/Sigmoidoscopy/Biopsy

Answer 195

- Colonoscopy- whole bowel tract | - Can drop BP, dehydration

Question 196

Enemas

Answer 196

- Promote defecation by peristalsis - Different types of cleansing enemas----tap water, soap suds, oil retention, hypertonic, normal saline, medicated, carminative (accelerates defecation) - Prior to administering enema important to assess----last bowel movement, normal bowel patterns, hemorrhoids, mobility, abdominal pain, external sphincter control - Bowel is meant to absorb fluid - Hypertonic- draws fluid from bowel to the lumen - Make clear path to bathroom

Question 197

Types of enemas: Cleansing enemas

Answer 197

- Promotes complete evacuation of feces from the colon - Stimulate peristalsis through infusion of large volume of solution or irritation of colon’s mucosa - Include tap water, NS, soapsuds, hypertonic saline - Maximum volume to be given is 1000ml - for an adult and children age/size. - Warm solution - Sims position, waterproof pad - Make sure bedpan/commode is accessible - Lubricate end of tubing - Slowly insert 3-4 inches, directed angle pointed toward the umbilicus - Introduce solution slowly over a period of 5 to 10 minutes - Remove tubing when solution administered - Retain the fluid until strong urge (5-15 min) - Assist position to defecate, provide cleaning, document - High hot and hell of a lot- how not to give it - Turn to left side - If they cramp- just pause for a minute

Question 198

Assessment during and after enema administration

Answer 198

- Assess patient for abdominal cramping, rigidity, bleeding or distention of abdomen - Inspect color, and consistency of stool - Estimate/measure amount of stool and fluid that is passed - Assess amount of flatus expelled - Clear: No more stool left

Question 199

Suppositories

Answer 199

-Used to administer medication to be absorbed by the intestinal mucosa -Examples of medicines Fever: acetaminophen Nausea/vomiting: Prochlorperazine or Promethazine Laxative: Bisacodyl, Dulcolax, glycerin Pain relief: Fentanyl -Get suppositories to lay alongside wall and past sphincter

Question 200

Rectal Suppository Insertion

Answer 200

- Sims position or standing - Lubricate suppository - Insert past internal sphincter, 4 inches in adults, 2 inches in children - Lay flat for 5 minutes - Do not embed suppository in the fecal mass - Make sure call light is within reach - Tell patient to call you when they have a bowel movement (see it) - Parasites and ova - children- common to have pinworms (dirt), place piece of tape against rectum

Question 201

Digital impaction stool removal

Answer 201

- Impaction: collection of hardened stool wedged in the rectum - Can be palpated by rectal digital exam - Signs: oozing of liquid stool, frequent urge to defecate, rectal pain - Try oil retention enemas, enemas or suppositories first. - LAST RESORT !!! - Breakup and remove stool with fingers - Very uncomfortable and embarrassing - MUST have an order to do it

Question 202

Safety

Answer 202

Freedom from psychological and physical injury Basic human need Nurse use critical thinking and clinical reasoning to maintain safety Responsibility to be engaged in activities that support a patient centered safety culture

Question 203

QSEN

Answer 203

``` -Quality and Safety Education for Nurses (QSEN) aimed at creating a safe healthcare environment -Six Competencies: safety patient centered care teamwork and collaboration evidence-based practice quality improvement Informatics ```

Question 204

Safety Initiatives

Answer 204

- The Joint Commission and CMS "Speak Up" Campaign: Have pt’s take an active role in their healthcare. Helps to prevent errors. - National Quality Forum mission - QSEN

Question 205

Joint Commission National Patient Safety Goals 2020:

Answer 205

1: Identify patients correctly 2: Improve communication 3: Use medicine safely 4: Use alarms safely 5: Prevent infection 6: Identify patient safety risks 7: Prevent mistakes in surgery

Question 206

Environmental Safety

Answer 206

-A patient’s environment includes physical and psychosocial factors that influence or affect the life and survival of that patient -Basic Needs: Oxygen Temperature control: Prolonged periods of cold can lead to frost bite or hypothermia. -Nutrition

Question 207

Environmental Hazards

Answer 207

- Pollution - Water - Air quality - Lead poisoning - Noise - Sun exposure - Home

Question 208

Physical Hazards

Answer 208

- Car accidents: Leading cause - Falls - Fire - DIsasters

Question 209

Transmission of pathogens

Answer 209

- Pathogens and parasites - Hand hygiene - Immunization: Help prevent the transmission of disease from person to person. - Handwashing and hand hygiene is the best prevention strategy

Question 210

Disaster Planning

Answer 210

- Personal and professional preparedness - Be aware of the disaster plan at place of employment - Maintain CPR(BLS) certification - Participate in mock disaster drills - If occurs in the community and the nurse is the first responder to the scene attend to the victims with life threatening issues first - Disasters-need to know what actions need to be taken-each hospital will have its own emergency management plan

Question 211

Annual Employer Safety Quizzes and competency Fairs

Answer 211

- Many employers require annual safety quizzes to be completed by their employees - Many employers require annual competency fairs where assigned skills are to be completed by employees

Question 212

Factors influencing patient safety

Answer 212

- Lifestyle Choices: What we are choosing to do that impacts our safety. - Mobility Status: How well you are able to get up. - Sensory Status: Impaired cognition, delirium, dementia, depression. Alter concentration and attention span, impaired memory. - Cognitive Status: Nursing homes, very confused about their surroundings in the hospital. - Basic Safety Knowledge: If our pt’s don’t know how to adequately take care of themselves. Education is very important.

Question 213

Risks at Developmental Stages

Answer 213

- Children younger than 5 are at greatest risk for home accidents that can result in severe injury or death. - School-age child: At risk for injuries at home and at school. They perform more complicated motor activities, but still have some uncordination. - Adolescent: Automobile accidents, suicide, substance abuse. - Adult: Lifestyle habits - Older Adult: Physiological changes that happen with aging. Increasing medication use.

Question 214

Pediatric National Safety Initiatives

Answer 214

- Falls - Burns related to heat and fire - Motor vehicle accidents - Suffocation and choking - Drowning - Sports and recreation injuries - Poisoning

Question 215

safety issues in Acute Care

Answer 215

``` Falls- unsteady Restraints Medication errors Procedure errors Fires- know what to do Environmental risks- chemical Equipment malfunctions/Electrical hazards Seizures- precautions Radiation Disasters ```

Question 216

fostering pt safety in acute care

Answer 216

- risk managment - safe work environment - access to resources - technology: bed alarms are new - continuing education: stay up to date

Question 217

nursing diagnosis for pt with safety risk

Answer 217

``` Risk for falls Impaired home maintenance Risk for injury Deficient knowledge: do they know how to keep themselves safe? Risk for poisoning Risk for suffocation Risk for trauma ```

Question 218

planning for pt with safety risk

Answer 218

- Patient safety – priority - Look at actual safety risks and potential - Goals and outcomes: Prevent and minimize safety threats - Setting priorities - Teamwork and collaboration (physical therapy, their family)

Question 219

implementation for pt with safety risk

Answer 219

- Direct interventions toward maintain a patient’s safety in all types of settings - Patient Education - Health promotion - Developmental interventions - Lifestyle - Environmental interventions - Basic needs - General preventive measures - Modifying the environment - Infant- education to parents - School age- towards safety as school and play - Adults- lifestyle choices (drinking, nutrition, use of firearms) - Older adults- reduce risk for falls, other side effects of aging

Question 220

bed/side rails

Answer 220

- Increase patient mobility and/or stability - Most commonly used restraint - Can cause falls or death used with caution, especially with older adults and people with altered cognition, physical limitations, and certain medical conditions. - Appropriate to have all 4 rails up only when transporting- otherwise it is a restraint

Question 221

how can you improve safety?

Answer 221

- Minimize risk of harm to patients and providers through both system effectiveness and individual performance. - Two patient identifiers - Patient armbands - Medication reconciliation - Standardization of medications(IV pumps with medications and rates of administration) - Time outs

Question 222

fire safety

Answer 222

``` RACE: Rescue patients in immediate danger Active the alarm Confine the fire Extinguish the fire ``` ``` PASS: Pull the pin Aim at the base of the fire Squeeze the handle Sweep from side to side ``` - Keep spaces free from clutter - Know the fire drill and evacuation plan - Turn off oxygen and appliances near fire - Move patients to a safe area

Question 223

seizure precautions

Answer 223

Nursing interventions: - To protect the patient from traumatic injury - Position for adequate ventilation and drainage of oral secretions - Provide privacy and support following the seizure - Padding side rails - Keep bed in lowest position - Keep head safe - Side lying position after seizure - Do not put anything in patients mouth!!

Question 224

equipment and electrical safety

Answer 224

- Equipment must be maintained in good working order - Check for exposed frayed cords or damaged wires - Read warning labels - Never use electrical appliances near water - Never pull a plug by the cord

Question 225

radiation safety

Answer 225

``` - Label potentially radioactive material To reduce exposure: - Limit time spent near the source - Create as much distance as possible - Use a shielding device (Time, Distance, device) ```

Question 226

home hazard safety

Answer 226

- Assess and observe the patient in their home - Physical barriers-both patient and home - Nutrition - Environment

Question 227

security planning

Answer 227

- Know your hospital’s security plan and procedures | - Use critical thinking to protect yourself from potentially dangerous situations

Question 228

Restraints

Answer 228

Restraint use must meet one of the following objectives: - Reduce the risk of patient injury from falls (not usually just for falls) - Prevent interruption of therapy such as traction, IV infusions, nasogastric (NG) tube feeding, or Foley catheterization - Prevent patients who are confused or combative from removing life-support equipment - Reduce the risk of injury to others by the patient - Considered as a last resort when other alternatives have been unsuccessful

Question 229

acute and restorative care

Answer 229

- ongoing assessment (every 15 minutes) - Nursing home laws prohibit nonemergency restraints - Chemical restraints - If in restraints- do good documentation every 2 hours - Must have an order for restraints

Question 230

types of restraints

Answer 230

- posey bed - Mitten restraints (for pickers)- still have arm mobility - Wrist restraint (not a lot of arm movement) - Leather restraints- lock and key (a lot of times for a drug high)

Question 231

effective use of restraints

Answer 231

RESTRAINT: - Respond to the present condition of the patient and need for restraint - Evaluate potential for injury-risk for harming self or others - Speak with family members/caregivers - Try alternative measures - Reassess the patient - Alert the PCP if restraints are indicated - Individualize restraint use-choose least restrictive device - Note important information - Time-limit the use of restraints

Question 232

safety issues with restraints

Answer 232

- Natural tendency to remove restraint….entangled…strangulation - Pressure ulcers - Pneumonia - Constipation - Fecal and urinary incontinence/retention - Contractures: if they cannot move arm - Circulatory impairment - Loss of self esteem - Anger/Fear - Goal for health care organizations is to be restraint free - Must be ordered by a physician and the physician must come and see patient- within 24 hours - Must conduct ongoing assessment of restraints to assess skin, circulation and need every 2 hours - Restraints must be removed for periods of time and the need for them reassessed - Tie to bed frame with quick release DOCUMENT, DOCUMENT, DOCUMENT!!!

Question 233

restraint documentation

Answer 233

``` Time placed Assessment of patient Alternatives to restraints tried Patient Monitoring When removed ```

Question 234

alternatirves to restraints

Answer 234

- Reorient patient to surroundings - Companionship - Music, television - Offer frequent toileting opportunities - Evaluate pain frequently - Remove cues that promote leaving - Assign confused patients rooms close to nurses station for easier monitoring - Promote normal sleep patterns

Question 235

pediatric restraints

Answer 235

Behavioral Medical/Surgical: Mummy or swaddle restraints, jacket restraint, arm/leg restraints Therapeutic hugging/holding - Not seen a lot- More to protect them from medications and things they are receiving

Question 236

evaluation for restraints

Answer 236

- Through pt eyes: is the pt expectations met? is the families expectatios met? - patient outcomes: safe phsyical environment, knowledge of safety factors/precautions , free from injury