Mca1 test 1 review

Question 1

Less strict regulations raising a concern for its safety
They do not receive the same stringent oversight in their preparation as drugs → cause a range of patient responses depending on their nature and how they were prepared
Sold as standardized extracts and are more likely to contain larger amounts of the herb/nutritional element → less likely to contain inactive ingredients or fillers
Although it is labeled “natural”, it does not mean the herb is safe. Also, because it is safe does not mean that it is effective.
Can have pharmacoactive effects that can be serious or deadly → overuse, inappropriate use, supplement toxicities, supplement-drug or supplement=supplement interactions.
May delay diagnosis and treatment

Answer 1

Risks & effects associated with herbal preparations

Question 2

What is CAM ( (complimentary alternative medicine)) best used for 3 things?

Answer 2

1) anxiety
2) pain management
3) both

Question 3

What forms of CAM is known to treat anxiety?

Answer 3

Pet therapy or visitation
improves patients’ motor skills, increases ability to concentrate, increases socialization, keeps the person in touch with reality.

Question 4

What forms of CAM is known to be used for pain management? (3)

Answer 4

Aromatherapy
Uses essential oils from various plants and trees to enhance psychological and physical well-being. It stimulates the brain to decrease pain, improve mood, or enhance cognitive function.
Acupuncture
An ancient healing art that uses the fingers to press certain points on the body to stimulate the body’s self-healing ability. Shown to be effective in managing problems like: urinary incontinence, back pain, joint pain, and PTSD.
Tai Chi

Question 5

What form of CAM is used to treat both anxiety and pain management? (5)

Answer 5

Imagery
The formation of a mental representation of an object, place, event, or situation that is perceived through the patient’s senses. All senses can be used in imagery. (ex, ask patient to think about a beautiful scene while doing procedures that may produce pain).

Meditation
A self-directed practice for relaxing the body and mind. (ex, mental representation such as using a mantra; physical repetition such as focusing on breathing or walking; problem contemplation such as solving a riddle; visual concentration that is similar to imagery)

Music therapy
Often calms agitated patients and provides reminiscence for older adults. It may improve depression and lower blood pressure. Helps reduce postoperative abdominal pain during the first 24 hours after surgery. Music in the hospital setting can decreases pain and anxiety and allow patients more satisfaction with their care.

Yoga
Breathing and posturing through stretching, positioning, and posturing exercises that help to decrease blood pressure, increase heart and respiratory function, improve physical fitness, and decrease anxiety. Also used as an adjunct in management of patients with MS, rheumatoid arthritis, and other chronic/debilitating diseases.

Massage
- helps produce relaxation, lessen aggressive behaviors in patients with dementia, reduce pain, and decrease blood pressure in some patients. It involves various strokes and pressure to manipulate soft tissues for therapeutic purposes. Types include Swedish, Esalen, neuromuscular, Shiatsu, and reflexology.

Question 6

List some inappropriate uses for CAM

Answer 6

Herbal preparations that are self-administered to treat serious health problem that could more effectively be treated by conventional medicine
e.g. at patient may take St. John’s wort for depression rather than be evaluated for possible psychotherapyy and/or drug therapy

Question 7

What is the appropriate response to a patient when they are requesting the nurse to
participate in a CAM with them

Answer 7

Nurses using CAM as part of their daily practice should also ensure that this formally comprises part of their contracted work, and that codes of conduct or policy protocols are in place before they practice and that they have management approval.Although complementary and alternative therapies usually are included within the scope of nursing practice, they are not specifically addressed in some State Board of Nursing practice acts. Some therapies require additional education, training, and/or supervision. Nurses must check with the Board of Nursing in their state to determine what therapies fall within the nursing domain. The nurse is expected to obtain the necessary additional education and experience to be competent to use a selected therapy. Institutional or workplace policies supporting the use of these therapies must be in place.

Question 8

Skin management for lupus? (2)

Answer 8

topically and systemically

Question 9

What are the major concerns patients have about Lupus (2)?

Answer 9

Discoid lesions and skin changes

Question 10

What is used to treat skin lesions of lupus?

Answer 10

1) anti-malarial agent hydroxychloroquine (Plaquenil-decreases the absorption of ultraviolet light by the skin and therefore decreases the risk for skin lesions
2) Topical cortisone preparations- help reduce inflammation and promote fading of the skin lesions

Question 11

What may be used to treat musculoskeletal problems like arthritis and myalgias of Lupus?

Answer 11

Acetaminophen (Tylenol) or NSAID

Question 12

What is the best way to manage the systemic manifestations of SLE Lupus

Answer 12

Treat the disease aggressively until remission.

Question 13

What does the health care provider often prescribes to treat the systemic disease process of Lupus?

Answer 13

1) chronic steroid therapy
2) methotrexate (Rheumatrex) or azathioprine (Imuran)- for renal or central nervous system lupus (both are immunosuppressive agents )
3) high-dose IV bolus of glucocorticoids, cyclophosphamide, and plasmapheresis
4) Renal transplantation

Question 14

Evidence-Based Practice for Skin Protection in Patients with Lupus Erythematosus

Answer 14

Cleanse your skin with a mild soap, such as Ivory.
• Dry your skin thoroughly by patting rather than rubbing.
• Apply lotion liberally to dry skin areas.
• Avoid powder and other drying agents, such as rubbing alcohol.
• Use cosmetics that contain moisturizers.
• Avoid direct sunlight and any other type of ultraviolet lighting, including tanning beds.
• Wear a large-brimmed hat, long sleeves, and long pants when in the sun.
• Use a sun-blocking agent with a sun protection factor (SPF) of at least 30.
• Inspect your skin daily for open areas and rashes.

Question 15

What hair condition is common with lupus?

Answer 15

Alopecia-Recommend the use of mild protein shampoos and the avoidance of harsh treatments (e.g., permanents or highlights) until the hair regrows during remission

Question 16

The preoperative care and teaching for patients undergoing a TKA are similar to?

Answer 16

Total hip replacement

Question 17

When is TKA performed?

Answer 17

When activity and mobility severely prevent patients from participating in work or activities they enjoy, this procedure can restore a high quality of life

Question 18

What is MIS? What is the advantage of this procedure?

Answer 18

• minimally invasive surgery, performed using a shorter incision and special instruments to spare muscle and other soft tissue
• less blood loss during surgery, less pain, more joint range of motion (less stiffness from scarring), and a faster recovery, leading to a shorter hospital stay

Question 19

Who are candidates for mini–knee replacement

Answer 19

patients that do not have severe bone loss, obesity, or previous knee surgery

Question 20

Who provide information about transfers, ambulation, postoperative exercises, and ADL assistance.

Answer 20

PT and OT

Question 21

What devices can TKA patients use in recovering from surgery?

Answer 21

• walkers or crutches
• assistive-adaptive devices to assist with ADLs, including an elevated toilet seat, safety handrails, and dressing devices like a long-handled shoehorn
• continuous passive motion (CPM) machine after knee surgery to increase joint mobility

Question 22

What type of diagnostic testing is required for TKA?

Answer 22

1) cervical spine x-rays- for patients with rheumatoid arthritis (RA) to determine if the patient can be intubated for anesthesia
2) Knee x-rays, CT scan, and/or MRI may be done to assess the joint and surrounding soft tissues.

Question 23

What does patient need to do before TKA surgery?

Answer 23

Teach patients that they will need to shower with a special antiseptic soap the night before surgery to decrease bacteria on the skin that could cause infection after surgery. Remind them to wear clean nightwear and sleep on clean linen. Ask them to check with their surgeon about what medications they can take the morning of surgery, including antihypertensives. Take these drugs with a small amount of water to prevent vomiting and aspiration during surgery.

Question 24

What is used to prevent pain and infection during TKA ?

Answer 24

general or neuroaxial (epidural or spinal) anesthesia. An antibiotic, usually an IV cephalosporin, is given shortly before surgical opening

Question 25

CPM use and related tasks that can be delegated to a UAP (Unlicensed Assisted personal)

Answer 25

• Ensure that the machine is well padded. ·• Check the cycle and range-of-motion settings at least once every 8 hours. · • Ensure that the joint being moved is properly positioned on the machine. · • If the patient is confused, place the controls to the machine out of his or her reach. · • Assess the patient's response to the machine. • Turn off the machine while the patient is having a meal in bed. • When the machine is not in use, do not store it on the floor.

Question 26

Who are central to dysphagia management?

Answer 26

The speech language pathologist SLP and registered dietitian (RD)

Question 27

What does the RD do win dysphagia management?

Answer 27

ensures that recommendations are balanced with the nutritional and caloric needs of patients. Appropriate food choices and consistency of liquids are individualized and based on which phase of swallowing is dysfunctional

Question 28

What are common diet modifications.in dysphagia patients?

Answer 28

Changes in food and/or liquid consistencies, elimination of oral intake, and initiation of tube feedings

Question 29

The diet for dysphagia patients comprises of four levels, what are they?

Answer 29

1) Dysphagia pureed 2) Dysphagia mechanically altered 3) Dysphagia advanced 4) Regular

Question 30

Which dysphagia diet phase is the following? Uniform, pureed, cohesive, pudding-like texture eg: Smooth hot cereals cooked to a “pudding” consistency; mashed potatoes; pureed meat and vegetables; pureed pasta on rice; yogurt

Answer 30

Dysphagia pureed

Question 31

Which dysphagia diet phase is the following? Moist, soft textured. Easily forms a bolus Cooked cereals; dry cereals moistened with milk; canned fruit (except pineapple); moist ground meat; well-cooked noodles in sauce/gravy; well cooked, diced vegetables

Answer 31

Dysphagia mechanically altered

Question 32

``` Which dysphagia diet phase is the following? Regular foods (except very hard, sticky, or crunchy foods) Moist breads (e.g., butter, jelly); well-moistened cereals, peeled soft fruits (peach, plum, kiwi); tender, thin-sliced meats; baked potato (without skin); tender, cooked vegetables ```

Answer 32

Dysphagia advanced

Question 33

Which dysphagia diet phase is the following? | All foods

Answer 33

Regular

Question 34

Why are Thickened liquids commonly prescribed to patients with dysphagia?

Answer 34

To prevent aspiration pneumonia

Question 35

(Garcia et al., 2010). Why are There are often complaints about their (thickened food) taste and thickness, which increase nonadherence

Answer 35

A thickening agent alters flavor and texture qualities

Question 36

What is important to remember in altering thickness of a liquid (patient with dysphagia)

Answer 36

the patient's swallowing deficit.

Question 37

What happens when a patient's diagnostic tests reveal aspiration with all food and liquid consistencie?

Answer 37

intravenous fluids (parenteral nutrition) (see Chapter 32) may be initiated short term to maintain hydration (see Chapter 28) until alternatives for oral nutrition are discussed and accepted by the patient for nutritional support

Question 38

What type of feeding is used for long-term nutritional support

Answer 38

Enteral nutrition (tube feeding)

Question 39

Who makes treatment recommendations to the health care provider that may include texture modifications for food and liquids for dysphagia patients?

Answer 39

An SLP (Speech Language Pathologist) specializes in swallowing disorders and

Question 40

Expected subjective symptoms of chronic fatigue syndrome (information supplied to you by the subject, or patient)

Answer 40

``` Muscle pain Tender lymph nodes Sore throat Headaches of a new type, pattern, or severity (not familiar to the patient) Unrefreshing sleep ```

Question 41

Expected objective symptoms of chronic fatigue syndrome

Answer 41

Multiple joint pain with redness or swelling Substantial impairment in short-term memory or concentration Postexertional malaise lasting more than 24 hours

Question 42

is a chronic illness in which patients have severe fatigue for 6 months or longer, usually following flu-like symptoms

Answer 42

Chronic fatigue syndrome (CFS

Question 43

CFS is common in who?

Answer 43

Women of all backgrounds

Question 44

Is there a cure for CFS?

Answer 44

No, Treatment is supportive and focuses on alleviation or reduction of symptoms

Question 45

How are alleviation or reduction of symptoms of CFS done?

Answer 45

NSAIDs- may help with body aches and pain. Low-dose antidepressants- may also be effective in promoting sleep and preventing or treating depression. Healthy practices-such as adequate sleep, proper nutrition, regular exercise (but not excessive to increase fatigue), stress management, and energy conservation. Complementary and alternative therapies- such as acupuncture, tai chi, massage, and herbal supplements, may be helpful for some patients

Question 46

How to increase likelihood of medication compliance on discharge

Answer 46

Assess patient’s ability to prepare doses and take medication correctly. If not, assess if family members or friends are available to assist or to make home are arrangements. Notify the patient’s health care provider if he/she is unable to take a medication (ex. unable to swallow tablet) Observe patient’s behavior for evidence of drug dependence or drug avoidance. Be aware that cultural beliefs about western medicine sometimes interfere with medication compliance. Patient’s understanding of medication therapy influences willingness or ability to follow a medication regimen. If patient has history of frequently missing doses, investigate to find out if its economic issue and are there resources that are available to help. Patients need adequate knowledge and motivation in adhering to medication schedules. Make sure patients know well of the possible side-effects, adverse effects, and precautions. Teach patient foods that may interact with medication actions / or if the medication must be taken with food. Assess learning needs. Make sure patient fully understands technical terminology, literacy regarding medication administration instructions. Assess patient’s knowledge about drugs to prevent serious errors.

Question 47

What are all the following expamples of ? - non judgemental acceptance of a patient is an important characteristic of the relationship - active listening, learn to be comfortable with silence, and use prompts “tell me more” to encourage continued conversation. Empathize with the patient’s grief’s; offer your caring, transformative presence and use intentional, meaningful touch - Providing information helps patients understand their condition, the course of the disease, and the benefits and burdens of treatment options - Remain supportive by letting patients and family members know that feeling such anger are normal, and that you will be available to listen and talk if they want to. - Invite patients to reveal the emotions and concerns of greatest importance. - - view emotional expression as a necessary part of the patient’s adjustment to significant life changes and development of effective coping skills.

Answer 47

Therapeutic Communication

Question 48

Discharge instructions for: a post-hip surgery patient (Care of Patients w/ Total Hip Arthoplasty after Hospital Discharge)

Answer 48

``` Collaborate with pt and family to become safety partners to keep patient free from harm including complications such as hip dislocation venous thrombo embolism (VTE) infection anemia neurovascular compromise ``` Do not sit or stand for prolonged periods Do not cross legs beyond midline of body Do not bend hips more than 90 degrees Do not twist body when standing Use ambulatory aid, i.e., walker, when walking Use assistive/adaptive devices for dressing, such as for putting on shoes/socks Do not put more weight on affected leg than allowed Resume sexual intercourse as usual on the advice of surgeon

Question 49

Discharge instructions for: osteoarthritis patient,

Answer 49

Lifestyle changes can prevent or slow joint degeneration Keep body weight w/i normal limits; obesity causes excess wear on joints esp knees and hips Stop or don’t start smoking Avoid or limit activities that promote stress on joints unless absolutely necessary Limit participation in rec sports that can damage joints, i.e., football Wear supportive shoes to prevent falls and damage to foot joints esp metatarsal joints Do not perform repetitive stress activities, i.e., knitting or typing, for prolonged periods Avoid risk-taking activities to prevent trauma that can result in OA later in life DRUGS: For topical applications that temp relieve pain like Lidocaine 5% patches: teach patient to apply patch on clean intact skin for 12 hrs each day. Up to 3 patches can be applied to painful joints at one time. May cause skin irritations. Contraindicated for those on class I antidysrhythmics For muscle relaxants: remind patient not to drive or operate dangerous machinery NONPHARMACOLOGIC: (Iggy, 321-323) Rest unstable joints like knee with splint or brace Use ambulatory aid; cane should be used on strongest side of body Sleep 8-10 hours a day and rest an additional 1-2 hours a day Get local, systemic and psychological rest daily Position joints in their functional positions Elevate legs 8-12 inches to reduce back discomfort Use proper posture when standing and sitting to reduce undue strain on vertebral column Wear supportive shoes to relieve pressure Apply heat or cold for temp relief; make sure heat source is not too heavy or so hot that causes burns Well balanced diet If taking topical capsaicin product, tell pt to expect burning sensations If taking glucosamine supplements (may decrease inflammation) discontinue if no improvement in 6 months of use tell health provider if do decide to take glucosamine don’t take if have hypertension, pregnant or breastfeeding monitor for bleeding if taking chondroitin( may play role in strengthening cartilage) if on anticoagulant therapy if diabetic, monitor blood glucose levels because glucosamine can increase them be aware of adverse effects i.e., rash, GI disturbance, diarrhea, drowsiness, headache take recommended dosage based on weight read drug labels to ensure you don’t take too much for weight; some drug names may not indicate they contain glucosamine

Question 50

Pain Management for patient with Total Hip Arthoplasty after Hospital Discharge

Answer 50

Report increased hip pain to dr immediately Take oral analgesics as prescribed only when needed Do not overexert yourself, take frequent rests

Question 51

INCISIONAL CARE for Total hip Arthoplasty after hospital discharge

Answer 51

Inspect hip incision everyday for redness, heat or drainage. If any present, call dr stat Cleanse hip incision with mild soap and water everyday, dry thoroughly

Question 52

OTHER CARE for Total hip Arthoplasty after hospital discharge

Answer 52

Continue walking and performing leg exercises as learned in hospital Do not cross legs to prevent blood clots Report, pain, redness or swelling to dr stat Report chest pain or SOB to dr stat If taking anticoagulants, follow precautions learned in hospital to prevent bleeding, avoid using straight razor, avoid injuries, and report bleeding or excessive bruiding to surgeon stat Perform postop exercises as instructed including straight leg raises, gluteal sets, ankle pumps, and “ham sets”

Question 53

Population at risk for untreated pain

Answer 53

The older adults are at great risk for undertreated pain.

Question 54

What beliefs and concerns do older people have about pain?

Answer 54

Pain is something that must be lived with. · Expressing pain is unacceptable or a sign of weakness · Reporting pain will result in being labeled a “bad” patient · Nurses are too busy to listen to reports of pain. · Pain signifies a serious illness or impending death.

Question 55

What is a Cataract

Answer 55

lens opacity that distorts the image projected onto the retina. With aging, the lens gradually loses water and increases in density. This increased density occurs as older lens fibers are compressed and new fibers are produced in the outer layers. Lens proteins dry out and form crystals. As the density of the lens increases, it becomes opaque with a painless loss of transparency. Both eyes may have cataracts; however, the rate of progression in each eye is usually different.

Question 56

How do people get Cataract?

Answer 56

1) Older age- 2) heavy sun exposure or exposure to other sources of ultraviolet (UV) light. 3) direct eye injury

Question 57

What is the cure for cataracts?

Answer 57

Surgery, ...it is done when vision is reduced to the extent that ADLs are affected,

Question 58

When do patients experience improvement after surgery?

Answer 58

improvement in vision on the day of surgery. Remind them that final best vision will not be present until 4 to 6 weeks after surgery. However, vision is not expected to become worse after the procedure.

Question 59

Is radiation to the eye considered Trauma causing cataract?

Answer 59

Yes

Question 60

What are forms of Toxic Cataracts?

Answer 60

Corticosteroids Phenothiazine derivatives Miotic agents

Question 61

Disorders associated with Cataracts

Answer 61

Diabetes mellitus · Hypoparathyroidism · Down syndrome · Chronic sunlight exposure

Question 62

what causes hearing loss?

Answer 62

1) Chronic otitis media 2) occupational exposure to loud or continuous noises 3) ototoxic drugs 4) xternal ear or middle ear infection a 5) eardrum perforation occured 6) genetic 7) upper respiratory infection and allergies affecting the nose and sinuses-(onset of hearing loss is usually acute)

Question 63

How should you RESPOND to a patient experiencing hearing problems?

Answer 63

-Therapeutic communication • Reduce the background sound when speaking to the person (close the door to the hall, use a private area, turn off televisions and radios). • Speak slowly, distinctly, and with a deeper tone. • Face the patient while speaking. • Ensure that all members of the health care team are aware of the patient's impairment and use an appropriate method to communicate with the patient. • Determine whether the patient can communicate by sign language. • Identify safety issues specific for the patient with a hearing impairment. • Use a certified medical interpreter when taking a history from, explaining procedures to, or teaching the patient who has a hearing impairment.

Question 64

involves the use of a battery-operated device capable of delivering small electrical currents through up to four electrodes applied to the painful area (Fig. 5-6). The voltage or current is regulated by adjusting a dial to the point at which the patient perceives a prickly “pins-and-needles” sensation. The current is adjusted based on the degree of pain relief and level of comfort. (Ignatavicius 59)

Answer 64

TENS (Transcutaneous electrical nerve stimulation ) devices are most often used short-term and intermittently for patients with osteoarthritis or rheumatoid arthritis. (Ignatavicius 59)