PCC-1 Exam 3 Flashcards

Question

Diagnoses from immobility related to Urinary

Answer 1

Urinary stasis – When a patient is recumbent or flat, the kidneys and ureters are on a more even plane. Peristalsis in the ureters is not sufficient to overcome gravity. The renal pelvis fills before the urine enters the ureters. This increases the risk or UTI and renal calculi (plus hypercalcemia).

Answer 2

Exercise: increase appetite and GI tract tone, improves digestion and elimination Immobility: slowing of peristalsis, weakened defecation muscles, increase constipation, risk of impaction or bowel obstruction if constipation is severe

Answer 3

Exercise: increases blood flow which results in an increase in nutrients to tissues and removal of waste from tissues Immobility: decrease in skin turgor, increased risk of skin breakdown, delayed wound healing

Answer 4

Exercise: improves stress tolerance, produces relaxation, less risk of depression, improves body image and sleep, increases energy and appetite Immobility: changes to self-esteem, emotional changes, decrease perception of time, decrease in problem-solving and decision-making ability, changes in sleep/rest pattern

Answer 5

Pressure ulcer – an impairment of the skin as a result of prolonged ischemia (decreased blood supply) in tissues. Ischemia develops when the pressure on the skin is greater than the pressure inside the small peripheral blood vessels supplying blood to the skin. The longer the pressure is applied, the longer the period of ischemia and therefore the greater the risk of skin breakdown

Answer 6

Depression – an affective disorder characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness out of proportion to reality. Worrying quickly increases a patient’s depression, causing withdrawal. Withdrawn patients often do not want to participate in their own care.

Answer 7

Elbows should be flexed 30 degrees Never pull on the walker to stand up Walkers – stability and security during walking. Used for weak patients of those patient who have balance problems. Line up the walker with the crease of the wrist. If a walker does not have wheels the walker is meant to be lifted in-between steps. Rolling walkers can cause falls.

Answer 8

Hold can in opposite hand from the injured leg In case of arm weakness place can in stronger hand regardless Cane – Used when a patient has decreased unilateral leg strength. The cane is used on the strong side of the body. Two points of support are on the floor at all times. C- Canes O- Opposite A- Affected L- Leg

Answer 9

Gait is ordered by MD and typically taught by PT Nurses reinforce the training Monitor for safety Know how to measure 4-point gait is used for partial weight bearing of both extremities 3-point gait used for no weight bearing on the affected leg 2-point gait used for partial weight bearing on both extremities Swing-through gait used for paralyzed lower extremities Crutches – 2-3 finger widths from the axilla. Pressure on the axilla increases the risk to underlying nerves, which sometimes results in partial paralysis of the arm. Determine correct position of the hand grips with the patient upright, supporting weight by the handgrips with the elbows slightly flexed at 20-25 degrees. Crutch gait – alternately bearing weight on one or both legs and on the crutches. 2 point and 4 point require at least partial weight bearing on both legs 3 point allows for no weight bearing on the affected leg Swing-through is used for paralyzed lower extermities

Answer 10

``` Safety Preparation Types Moving toward the head of bed Bed-to-chair & chair-to-bed Bed to stretcher Logrolling ``` Things to assess before moving a patient? Physiological capacity (muscle strength, joint mobility, paralysis or paresis, bone continuity) Weakness, dizziness, orthostatic hypotension Activity tolerance Posture and equilibrium Sensory limitations Pain Vital signs Cognitive status Motivation Fall risk Previous transfer techniques used Accessibility and familiarity with equipment Study pages listed on slide 14 of Immobility powerpoint, also slide 15 for pictures of transference of patients

Answer 11

What are barriers to safe patient handling and encouraging early mobility? Box 39-1 p.791 & Table 39-1 p.804 P&P Mechanical lifts and lift teams are essential when a patient is unable to assist. When a patient is able to lift …. Wide stance, low center of gravity, equilibrium, face the direction of the movement, use arms and legs, leverage, reduce friction * Notice if the patient is unable to assist and >200 lbs= 3 or more care givers Figure 39-4 p.793 P&P Repositioning patient in bed Figure 39-5 p.794 P&P To and from chair to other device Figure 39-6 p.795 P&P lateral transfer

Answer 12

``` Post op Total Hip Arthroplasty Abduction pillow Do Not bend hip above 90 degrees Do not cross legs Do not bend forward to pick up objects Do not rotate leg when standing TEDs & SCDs Promote venous return Procedure ``` Box 28-7 Applying SCDs sequential compression devices and elastic stockings Nurse must measure to determine the correct size of elastic stockings and assess for impaired circulation or DVT. Assess for risks of Virchow’s triad = hypercoagulability, venous wall abnormalities, blood stasis DVT = redness, warmth, swelling, pain, & Homan’s sign – pain in the calf upon dorsiflexion of the foot

Answer 13

1. Respecting a patient’s health beliefs and understanding the effect of the patient’s beliefs on health care delivery 2. Shifting a model of understanding a patient’s experience from a disease happening in the patient’s organ systems to that of an illness occurring in the context of culture 3. Ability to elicit a patient’s explanation of an illness and its causes 4. Ability to explain to a patient the health care provider’s perspective on the illness and its perceived causes 5. Being able to negotiate a mutually agreeable, safe, and effective treatment plan Reiteration from Mrs. Campbell's notes of the 5 competencies: 1. Respecting a patient’s health beliefs as valid and understanding the effect of the patient’s beliefs on health care delivery 2. Shifting a model of understanding a patient’s experience from a disease happening in his or her organ systems to that of an illness occurring in the context of culture (biopsychosocial context) 3. Ability to elicit a patient’s explanation of an illness and its causes (patient’s explanatory model) 4. Ability to explain to a patient in understandable terms the health care provider’s perspective on the illness and its perceived causes 5. Being able to negotiate a mutually agreeable, safe, and effective treatment plan

Answer 14

``` Health disparity (inequality/gap) A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage ``` Health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases, and related complications. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g., screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. Addressing health disparities: New standards Focus on cultural competency, health literacy, and patient- and family-centered care Recognize that valuing each patient’s unique needs improves the overall safety and quality of care and helps to eliminate health disparities. African-Americans, Asians, & Hispanics less likely that non-Hispanic whites to see PCP regularly Less care available to people in low- and middle-income groups compared with high-income groups Uninsured people ages 0-64 years less likely to have regular PCP than those with private/public ins. Subgroups of LGBT community have more chronic health conditions and a higher prevalence & earlier onset of disabilities than heterosexuals

Answer 15

1. ) patient centered care 2. ) teamwork and collaboration 3. ) evidence-based practice 4. ) quality improvement/assurance 5. ) safety 6. ) informatics

Answer 16

Camphina-Bacote's models of cultural competency has five interrelated components: Cultural Awareness: an in depth self examination of one own's background, recognizing biases, prejudices, and assumptions about other people Cultural knowledge: : Sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, world view, and bicultural ecology commonly found within each group Cultural Skills: Ability to assess social, cultural, and biophysical factors that influence patient treatment and care Cultural encounters: Cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication Cultural desire: The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities

Answer 17

``` Defined as the enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients. Culturally competent organizations: Value diversity Conduct a cultural self-assessment Manage the dynamics of difference Institutionalize cultural knowledge Adapt to diversity ``` Expanding the original focus on interpersonal skills, many of the current approaches to cultural competency now also focus on: All marginalized groups and not just immigrants Prejudice, stereotyping, and social determinants of health The health system, communities, and institutions. You broaden your understanding of the world by learning about other people’s world views, which determines how people perceive others, how they interact and relate to reality, and how they process information. Cultural competency is dynamic and takes time to develop.

Answer 18

Blanchet and Pepin: depends on experience & interactions with patients and fellow clinicians Building a relationship with the other Working outside the usual practice framework Reinventing practice in action Blanchet and Pepin have recently described the processes involved in the development of cultural competence among registered nurses and undergraduate student nurses. Clinical experience and interactions with patients and fellow clinicians help to build cultural competency.

Answer 19

Nurses should accommodate each client’s cultural beliefs and values whenever possible, unless they are in direct conflict with essential health practices. The goal is to provide culturally competent care. Culturally sensitive – nurses are knowledgeable about the cultures prevalent in the area of practice. Culturally appropriate – nurses apply their knowledge of the client’s culture to their care delivery Culturally competent – nurses understand and address the entire cultural context of each client within the realm of the care they deliver. Culturally responsive – should encourage client decision-making by introducing self-empowering strategies. Culturally imposition – understanding and awareness of their own (nurses) culture and any culture biases that might affect care delivery.

Answer 20

Linguistic competence is the ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences. These audiences include people of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing.

Answer 21

LEARN: Listen, Explain, Acknowledge, Recommend, Negotiate RESPECT: Rapport, Empathy, Support, Partnership, Explanations, Cultural Competence, Trust ETHNIC: Explanation, Treatment, Healers, Negotiate, Intervention, Collaboration C-LARA: Calm, Listen, Affirm, Respond, Add

Answer 22

Motivation – a person’s desire or willingness to learn. Effected by previous knowledge, experience, attitudes, and sociocultural factors. *(Health Care providers make the worse patients) Ability – depends on the physical and cognitive attributes, developmental level, physical wellness, and intellectual thought processes. Environment- Effected by the # of people, need of privacy, temperature, lighting, noise, ventilation, furniture set up. Pg. 14 in Powerpoint

Answer 23

Health literacy: the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. Health literacy includes patients’ reading and mathematics skills, comprehension, and decision-making and functioning skills with regard to health care. Health Literacy is a strong predictor of a person’s health status. Results from a 2015 survey by the U.S. Department of Education, National institute of Literacy found that 32 million American adults have a below-basic level of health literacy. Studies show that patient with low literacy levels are 1.5 to 3 times more likely to expereicne adverse health outcomes and are at an increased risk for hospitalization that those at lower literacy levels. AT RISK = above the age of 65, minority populations, immigrant populations, low income, those with chronic mental of physical health conditions. The nurse should provide client education at the 6th grade reading level or below. Assess by asking patient to read a medication label, explain back simple step by step plans, describe back instructions on a written hand out.

Answer 24

Deficient knowledge (affective, cognitive, psychomotor) Ineffective health maintenance Impaired home maintenance Ineffective family therapeutic regimen management Ineffective self-health management Noncompliance (with medications) Nursing Diagnosis – Deficient Knowledge = the diagnostic statement describes the specific type of learning needed and it’s cause Ex. Deficient knowledge regarding (surgical procedure) related to lack of recall and exposure to information Ineffective Health Management = used when you can eliminate health care problems through education Ex. Ineffective Health Maintenance related to deficient knowledge regarding scheduling of medications

Answer 25

Cognitive Learning – acquiring knowledge and skills. Includes all intellectual behaviors and requires thinking Affective learning – development of values, attitudes, and beliefs. Deals with expression of feelings and acceptance of attitudes, opinions, or values. Psychomotor learning – acquiring motor skills (client must “physically do something”). Involves acquiring skills that require integration of mental and muscular activity.

Answer 26

Different teaching methods are appropriate for each domain of learning. Cognitive: discussion (one-on-one or group), lecture, question-and-answer session, role play, discovery, independent project, field experience- typical classroom type learning Affective: role play, discussion (one-on-one or group) Psychomotor: demonstration, practice, return demonstration, independent projects, games

Answer 27

- Telling – limited info, when client is anxious, specific task, no feedback - Participating – discussion, feedback, mutual goal setting, revision of plan - Entrusting- client self manages care and the nurse observes and assists - Reinforcement – use of a stimulus (positive or negative) Timing is essential so a clear correlation is made between the behavior and the stimulus. Incorporating teaching – Teach more effectively while delivering nursing care. Ex. Medication teaching while administering medication

Answer 28

- One-one-One – most common at bedside, give info, client can ask questions, use models and diagrams, can be unstructured - Group – economical, learn from experiences of others, discussion, share ideas, review common experiences. Leader guides participation. - Preparatory instruction – (tests or procedures) reduce anxiety. Describe common physical sensations and causes. When results will be available. - Demonstrations- psychomotor skills – use return demonstration (requires planning and organization) - Analogies = supplements verbal instructions with familiar images that make complex information more real and understandable. - be familiar with the concept - know the patient’s background, experience, culture - keep analogy simple and clear - Role Play – Patient learn a required skill by performing independently. The nurse offers feedback. - Simulation – teach problem solving, application, and independent thinking

Answer 29

Questions to ask when evaluating client education – 1. were the client’s goals or outcomes realistic and observable? 2. Is the client able to perform the behavior or skill in the natural setting (home)? 3. How well is the client able to answer questions about the topic? 4. Does the client continue to have problems understanding information or performing a skill? If so, how can you change the interventions to enhance knowledge or skill performance? Teach back – is a closed loop communication technique that assesses that client retention of the information imparted during the teaching session. Ask the patient to explain the teaching provided. Client understanding is confirmed when the client can accurately restte the information in his or her own words. See through the patient’s eyes. Have the patient’s learning needs been met? Evaluate a patient’s learning by observing performance of expected learning behaviors under desired conditions. Discontinue, adjust, or amend the plan. Patient outcomes: Legal responsibility Documentation

Answer 30

Teaching a Patient with Literacy or Learning Disability Literacy and other Disabilities - Impaired ability to analyze instructions, synthesize information, problem solve. Promote a safe, shame-free environment. Consider sensory deficits. - Establish trust, speak slowly, encourage questions, short sessions, appropriate teaching materials, appropriate analogies, model appropriate behavior, visual aids, Teach back, positive reinforcement. Teach Back – to determine understanding about a topic or ability to demonstrate a procedure. Determines level of understanding of instructional topic. Always revise you instruction or develop a plan for revised patient teaching if the client is not able to teach back correctly. Cultural Diversity – Assess and determine a patient’s beliefs, values, and customs as they relate to health. Box 25-7 p.350 P&P - use a trained and certified healthcare interpreter to provide health care information when a client can not understand english Teaching tools- Table 25-3 p.352 P&P. Select the right tool depending on the instructional method, learning needs, and ability to learn. - Printed Materials = easy to read, info accurate and current, use for complex concepts - Physical objects = teach concepts or skills, allows for the manipulation of objects used later in skill Special needs – Developmental needs of children, physical and psychological needs of older adults (sensory, memory) Assess family dynamics (high incidence of elder abuse) Box 25-8 p. 352 P&P Focus on Older adults – casual, personalized, lighting, large font, eliminate noise, sufficient time, use of prosthesis, concrete examples, step-by-step, short sessions, summarize.

Answer 31

``` The right patient The right medication The right route The right time The right dose The right documentation ```

Answer 32

Patient’s Full Name & Medical Record Number Date and Time order was written Medication Name Dosage Route of Administration Time and Frequency of Administration Signature of prescribing health care provider Patient’s with the same name need to be identified carefully with their medical record number. Labels for same name should be placed on the charts and prn medications to ensure patient safety. Clarify start and stop dates Medication Name – chemical name (molecular structure), Generic name (official publicized name), Trade name (marketed name) – Be familiar with Generic & Trade names Dosage = the strength of the medication- Nurse must understand pharmacokinetics (absorption, distribution, metabolism and excretion) Route – know accepted abbreviations, clarify orders, look it up * tPA Activace Time & Frequency – achieve a therapeutic range of a medication occurs between the toxic concentration and minimum effective concentration. Figure 32-2 p.614 P&P Signature – make sure the signature is legible so you can call for clarification.

Answer 33

Pg. 622 in P&P

Answer 34

Follow 6 Rights Read the label 3 times comparing with MAR Use at least 2 Pt Identifiers Do not allow any other activity to interrupt medication administration Double-check all calculations and verify with another RN Do not interpret illegible handwriting; clarify with prescriber Question unusually large or small doses Document all medications as soon as they are given

Answer 35

``` Client’s Safety is TOP Priority Assess Client Notify Physician Report to Nurse Manager Do not fear repercussions Reflect Opportunity to prevent future errors File Incident Report Do not document in medical record Report near misses ```

Answer 36

Accepted only if the physician cannot attend the patient and if the order is: Recorded in the medical record verbatim with date and time of the order Verified by reading back to and confirming with the physician Complete Countersigned by the physician as soon as possible If the nurse can not understand the order, a second nurse or supervisor should be asked to listen to the order

Answer 37

Oral – with or with out food? Risk for aspiration (BOX 32-13 p.635 P&P) – Self- administer, high-fowlers, assess after sipping water for voice change, cough, delayed swallowing, pocketing. Interventions – strong side of mouth, one at a time, thicken liquids, crush pills in purred food, avoid straws, well rested Contraindications/ Precautions – NPO (nothing by mouth), inability to swallow/ risk for aspiration (dysphagia), nausea, vomiting, bowel inflammation, recent GI surgery, gastric suction, decreased Level of consciousness. Determine if a medication can be crushed!!!! Ask the pharmacist or look it up!!!! **** Nursing intervention- Contraindication - Temporarily hold the medication and notify the prescribing health care provider and possibly the pharmacist. Safety – Medication reconciliation = check the accuracy and completeness of the MAR & the 6 patient rights, Check medication 3 times, avoid interruptions when administering medications, assess for allergies, hand hygiene, prepare medication one patient at a time. Position patient into a Fowlers, High Fowlers, or side lying position. The pharmacist should split, even pre-scored, medications and send to the unit packaged and labeled. (ISMP & USFDA recommendations of best practice) PCC – Assess client’s knowledge of medications, assess preferred beverages to take with medication, Place prepare unit-dose medications in medicine cup without removing wrapper. WHY? P.656 P&P. Assess the patient’s ability to self-administer medication. Explain the purpose, action, side effects and adverse effects of each medication. The patient has the right to refuse any medication or treatment. What should the nurse do if the patient refuses? Outcomes – Assess to make sure the patient swallowed the medication. Assess for desired response or adverse effect based on medication peak, Use teach back method. Document. Document. Document.

Answer 38

Topical – wear gloves, clean skin, remove old lotions, ointments and transdermal patches before applying new. Use sterile technique with an open wound. Label and document location medication was removed and new medication applied.

Answer 39

Eye- Age-related problems, including poor vision, hand tremors, and difficulty grasping or manipulating containers, affect the older adult’s ability to self- administer eye medications. Assess level of consciousness to reduce combative behavior when administering ophthalmic medications and preventing accidental eye injuries Warming eye drops to room temperature will reduce eye irritation Rolling eye drop container ensures medication is mixed and shaking causes bubbles increasing difficulty of administration. Instill ophthalmic ointment in a even this stream above the lower lid margin. This distributes medication evenly across the eye and lid margin. Place the intraocular disk in the conjunctival sac between iris and lower lid then gently pull the lower eyelid over the disk. You should not be able to see the disk. This ensures accurate delivery of the medication. -Can not be delegated to assistive personnel

Answer 40

Can not be delegated to assistive personnel. Explain positioning and sensation to expect such as hearing bubbling or feeling water in the ear Positioning Side lying unless contraindicated Straighten ear canal – pull pinna up and back (adults) Client remains side lying for 2-3 minutes Clean procedure Ear – Only use sterile solutions if the ear drum is suspected of or is ruptured. What may indicate ear drum rupture? Room temperature to prevent vertigo, dizziness, or nausea

Answer 41

Nasal – often self-administered. Caution overuse to avoid the rebound effect of worsening nasal congestion. Can not be delegated to Assistive personnel. Assess condition of nose and sinuses Instruct the client to clear or blow nose before administration unless contraindicated Administer nasal drops and spray with patient supine and head tilted appropriately Point nozzle of nasal spray to side and away from center of nose while gently closing other nostril. The client should hold their breath for a few seconds then breath from the mouth and avoid blowing nose for several minutes

Answer 42

Rectal – Often used to promote defecation or reduce nausea. Rectum is very vascular leading to systemic absorption. Can not delegate to assistive personnel. Review medical history for hemorrhoids, anal fissures, rectal surgery, or bleeding and allergies. Clean procedure Sims position Use water-soluble lubricating jelly Client should take slow deep breaths to relax the anal sphincter Insert suppository gently through anus, past the internal sphincter and against the rectal wall (4 inches in adults) Client should lie flat for 5 minutes to prevent expulsion

Answer 43

Can not be delegated to assistive personnel. Assess ability to self-administer medications Medication schedule and # of inhalations prescribed Provide patient education as needed and tolerated Important steps of medication administration Shake inhaler vigorously 5-6 times Have client sit up and take one deep breath in and out Client should tilt head slightly back and slowly and deeply inhale medication for 3-5 seconds Client should hold breath after administration for 10 seconds Exhale through pursed lips Wait 20-30 seconds between inhalations Wait 2-5 minutes between different inhaled medications Explain what metered dose is and warn the patient about overuse of inhaler, including medication side effects. This is because excessive inhalations increase risk of serious side effects. Inhalation administration – Shaking inhaler 5-6 times ensures fine particles are aerosolized. Having the client sit up and take a cleansing breath empties the lungs and prepares the airway to receive the medication. Inhaling slowly for 3-5 seconds with head slightly tilted distributes the medication into the airways through the mouth. The client should then hold their breath for 10 seconds to allow the tiny drops of aerosol spray to reach deeper branches of airways. The client should exhale through pursed lips to keep small airways open during exhalation. Medications should be inhaled sequentially. Always give bronchodilators before steroids. First inhalation opens airways. Second and third inhalation reduces inflammation and/or penetrates deeper airways

Answer 44

Carbohydrates Complex and simple saccharides Main source of energy Proteins Amino acids Necessary for nitrogen balance Fats Saturated, polyunsaturated, and monounsaturated Calorie-dense Water All cell function depends on a fluid environment Vitamins Essential for metabolism Water-soluble or fat-soluble Minerals Catalysts for enzymatic reactions Macrominerals; trace elements

Answer 45

Anabolism Building of more complex biochemical substances by synthesis of nutrients Catabolism Breakdown of biochemical substances into simpler substances; occurs during physiological states of negative nitrogen balance Nutrient metabolism consists of three main processes: 1. Catabolism of glycogen into glucose, carbon dioxide, and water (glycogenolysis). 2. Anabolism of glucose into glycogen for storage (glycogenesis). 3. Catabolism of amino acids and glycerol into glucose for energy (gluconeogenesis).

Answer 46

Eating patterns identify self-care ability and health vs. unhealth habits. Alternative diets are not supported. Usual weight – excess weight carries risk of hypertension, diabetes, heart disease, and cancer Changes – Interfere with adequate nutrient intake Recent conditions – increased caloric and nutrient needs (2-3 X) Chronic illness – cancer and chronic illness in crease risk for nutritional deficits GI symptoms – interfere with nutrient intake and absorption Allergies - peanut allergies on the rise Intolerances can cause deficiencies (intake or due to diarrhea) Medications – can impact digestion, absorption, and metabolism. Vitamins, minerals, herbals can have harmful side effects or adverse effects Patient centered care – poverty and lack of access to nutritious foods can lead to inadequate amount of all food groups and essential nutrients Alcohol- “empty calories”, can block absorption, can cause birth defects Exercise – caloric and nutrient needs increase with increased physical activity Family history – long term nutritional impairment may present as heart disease, osteoporosis, cancer, gout, GI disorders, obesity, or diabeties

Answer 47

Nutritional screening is a quick and easy way to identify individuals at nutrition risk such as those with weight loss, inadequate food intake, or recent illness. Screening includes: weight, weight history, conditions associated with risk, diet information, routine lab work. Malnutrition is estimated to occur in one third of hospitalized patients and is associated with adverse outcomes: impaired would healing, increased infection risk, suppression of immune system, functional loss with increased fall risk, increased risk of pressure ulcers, longer hospital stay, and increased mortality. During hospitalization documentation of nutritional intake is achieved through calorie counts of nutrients consumed and/or infused. 24- hour recall – elicit specific information about dietary intake over a specific period of time. Disadvantages = (1) client may not be able to recall, (2) last 24 hours may not be typical intake, (3) client may alter the truth, (4) snacks and gravies/sauces/condiments may be underreported Food frequency questionnaire- record how many times per day/week/month particular foods are eaten to estimate intake. Disadvantages = (1) does not always quantify amount of intake, (2) relies on memory Food diary – write down everything consumed over a period of time. Must teach to record immediately after eating. Disadvantages= (1) noncompliant, (2) inaccurate, (3) atypical recording, (4) conscious altering of diet Direct observation – of the feeding and eating process. Technology- photos of meals and tracking of meals

Answer 48

Birth to 4 months is the most rapid period of growth in the life cycle. Breastfeeding is recommended for full-term infants for the first year of life. No Cows milk until 1 yr of age – poor source of iron and V-C&E Whole milk from 1yr-2yrs old (brain development) Benefits of Breastfeeding 1. fewer food allergies and intolerances 2. reduced likelihood of overfeeding 3. less cost that infant formulas 4. increased mother-infant interaction Adolescence - Caloric, protein, calcium, & iron requirements increase to meet the rapid physical growth and endocrine and hormonal changes than cause bone growth, increasing muscle mass, and onset of menarche in girls. Pregnancy – national academy of sciences (NAS) recommends weight gain of 25-35 lbs for the normal weight woman. Increase of 28-40 lbs for underweight women, 15-25 lbs for overweight women, & 11-2- lbs for obese women. Adulthood – obesity is the cardinal sign. This syndrome carries increased cardiac risk and is diagnosed when a person has 3/5 biomarkers. (1) elevated BP, (2) increased fasting plasma glucose, (3) elevated triglycerides, (4) increased waist circumference, (5) low HDL high density lipoprotein. Aging Adult – Sarcopenia / sarcopenic obesity = age-related loss of muscle mass/ combined with increased body fat. It is attributed to a decrease in physical activity and a decreased protein intake with aging. Sarcopenic obesity results in a loss of muscle strength and function, decreased quality of life, physical frailty, and increased mortality rates. (resistance training)

Answer 49

Consider risk factors for new immigrants– unfamiliar foods, food storage, food preparation, food buying habits Consider cultural traditions- meal frequency and food quantity, ceremonial meals, fasting Consider religious practices – (Table 11-1, p.184) Should you assess a culturally diverse client using a 24 hour recall Newly arriving immigrants may be at nutritional risk because they frequently come from countries with limited food supplies resulting from poverty, poor sanitation, war, or political strife. General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries are among the more common nutrition related problems of new immigrants from developing countries. Buddhism – do not eat meat Catholicism- do not eat meat on ash Wednesday, good Friday, Fridays in Lent Hinduism – do not consume alcohol, beef, pork, fowl, red colored foods Islam – no pork, alcohol, fasting before sunset during Ramadan Mormon – no alcohol, caffeine, fasting the first Sunday of each month, Orthodox Judaism – no pork, no dairy and meat in the same meal, no leavened bread during Passover, no shellfish, Kosher preparation of meat Seventh-Day Adventists – no pork, no shellfish, meat, dairy, eggs, alcohol, coffee, tea

Answer 50

Nutritional Screening: -Malnutrition Screening Tool: Nutritional screening is a quick and easy way to identify individuals at nutrition risk such as those with weight loss, inadequate food intake, or recent illness. Screening includes: weight, weight history, conditions associated with risk, diet information, routine lab work. Malnutrition is estimated to occur in one third of hospitalized patients and is associated with adverse outcomes: impaired would healing, increased infection risk, suppression of immune system, functional loss with increased fall risk, increased risk of pressure ulcers, longer hospital stay, and increased mortality. Mini Nutritional Assessment: Like a 24 hour recall of what the patient had to eat

Answer 51

Dietary History- 24- hour recall – elicit specific information about dietary intake over a specific period of time. Disadvantages = (1) client may not be able to recall, (2) last 24 hours may not be typical intake, (3) client may alter the truth, (4) snacks and gravies/sauces/condiments may be underreported Food frequency questionnaire- record how many times per day/week/month particular foods are eaten to estimate intake. Disadvantages = (1) does not always quantify amount of intake, (2) relies on memory Food diary – write down everything consumed over a period of time. Must teach to record immediately after eating. Disadvantages= (1) noncompliant, (2) inaccurate, (3) atypical recording, (4) conscious altering of diet Direct observation – of the feeding and eating process. Technology- photos of meals and tracking of meals Also Physical exam, anthropometric measures, laboratory tests

Answer 52

Calculate body mass index (BMI) by dividing the patient’s weight in kilograms by height in meters squared: weight (kg) divided by height2 (m2). Waist-to-hip ratio >1.0 or greater in men and 0.8 or greater in women indicates android (upper body) obesity and increases the risk for obesity related disease and early mortality. A waist circumference of >35 inches in a woman and >40 inches in a man increases the risk for heart disease, type 2 diabetes, and metabolic syndrome

Answer 53

Obesity = 120% of standard weight with obese appearance BMI >30 waist- to-hip >1.0 in men & >0.8 in women BMI >40 = extreme or morbid obesity Marasmus – weight >80% standard weight with a starved appearance MAMC 0 mid upper arm circumference <90% Subcutaneous fat and muscle wasting Kwachiorkor – weight >100% standard with a well-nourishes appearance/edematous Caused by diets high in calories but little or no protein – Serum albumin <3.5 g/dL & Serum transferrin <150 mg/dL Mixed – weight <70% with emaciated appearance MAMC <60% , Serum albumin <2.8 g/dL & Serum transferrin <100 mg/dL Caused by inadequate intake of calories and protein such as severe starvation and catabolic states. Muscle, fat and visceral protein wasting. High risk for morbidity and mortality.

Answer 54

Diabetes Mellitus: Type 1 diabetes mellitus (DM) requires both insulin and dietary restrictions for optimal control, with treatment beginning at diagnosis (ADA, 2010). By contrast, patients often control type 2 DM initially with exercise and diet therapy. If these measures prove ineffective, it is common to add oral medications. Insulin injections often follow if type 2 DM worsens or fails to respond to these initial interventions. ``` Type 2: exercise and diet therapy initially Individualized diet Carbohydrate consistency and monitoring Saturated fat less than 7% Cholesterol intake less than 200 mg/dL Protein intake 15% to 20% of diet ```

Answer 55

Individualize the diet according to a patient’s age, build, weight, and activity level. Maintaining a prescribed carbohydrate intake is the key in diabetes management. The ADA recommends a diet that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk (American Dietetic Association, 2010b). Monitoring carbohydrate consumption is a key strategy in achieving glycemic control. Limit saturated fat to less than 7% of the total calories and cholesterol intake to less than 200 mg/day. In addition, varieties of foods containing fiber are recommended. Patients are able to substitute sucrose-containing foods for carbohydrates but need to make sure to avoid excess energy intake. Diabetics can eat sugar alcohols and nonnutritive sweeteners as long as they follow the recommended daily intake level. Patients with diabetes and normal renal function should continue to consume usual amounts of protein (15% to 20% of energy). The goal of MNT treatment is to have glycemic levels that are normal or as close to normal as safely possible; lipid and lipoprotein profiles that decrease the risk of microvascular (e.g., renal and eye disease), cardiovascular, neurological, and peripheral vascular complications; and blood pressure in the normal or near-normal range (ADA, 2010). Be aware of signs and symptoms of hypoglycemia and hyperglycemia.

Answer 56

American Heart Association (AHA) dietary guidelines Balance caloric intake and exercise. Maintain a healthy body weight. Eat a diet rich in fruits, vegetables, and complex carbohydrates. Eat fish twice per week. Limit foods and beverages high in sugar and salt. Limit trans-saturated fat to less than 1%. The goal of the American Heart Association (AHA) dietary guidelines is to reduce risk factors for the development of hypertension and coronary artery disease. Diet therapy for reducing the risk of cardiovascular disease includes balancing calorie intake with exercise to maintain a healthy body weight; eating a diet high in fruits, vegetables, and whole-grain high-fiber foods; eating fish at least 2 times per week; and limiting food and beverages that are high in added sugar and salt. The AHA guidelines also recommend limiting saturated fat to less than 7%, trans-fat to less than 1%, and cholesterol to less than 300 mg/day. To accomplish this goal, patients choose lean meats and vegetables, use fat-free dairy products, and limit intake of fats and sodium.

Answer 57

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) Body wasting and severe weight loss Severe diarrhea, GI malabsorption, altered nutrient metabolism Hyper-metabolism as a result of cytokine elevation Maximize kilocalories and nutrients Encourage small, frequent, nutrient-dense meals with fluid in between Patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) typically experience body wasting and severe weight loss related to anorexia, stomatitis, oral thrush infection, nausea, or recurrent vomiting, all resulting in inadequate intake. Factors associated with weight loss and malnutrition includes severe diarrhea, GI malabsorption, and altered metabolism of nutrients. Systemic infection results in hypermetabolism from cytokine elevation. The medications that treat HIV infection often cause side effects that alter the patient’s nutritional status. Restorative care of malnutrition resulting from AIDS focuses on maximizing kilocalories and nutrients. Diagnose and address each cause of nutritional depletion in the care plan. The progression of individually tailored nutrition support begins with administering oral, to enteral, and finally to parenteral. Good hand hygiene and food safety are essential because of a patient’s reduced resistance to infection. For example, minimization of exposure to Cryptosporidium in drinking water, lakes, or swimming pools is important. Small, frequent, nutrient-dense meals that limit fatty and overly sweet foods are easier to tolerate. Patients benefit from eating cold foods and drier or saltier foods with fluid in between.

Answer 58

Cancer and cancer treatment Malignant cells compete with normal cells for nutrients. Anorexia, nausea, vomiting, and taste distortions are common. Malnutrition associated with cancer increases morbidity and mortality. Radiation causes anorexia, stomatitis, severe diarrhea, intestinal strictures, and pain. Nutrition management. Malignant cells compete with normal cells for nutrients, increasing a patient’s metabolic needs. Most cancer treatments cause nutritional problems. Patients with cancer often experience anorexia, nausea, vomiting, and taste distortions. The goal of nutrition therapy is to meet the increased metabolic needs of a patient. Malnutrition in cancer is associated with increased morbidity and mortality. Enhanced nutritional status often improves a patient’s quality of life. Radiation therapy destroys rapidly dividing malignant cells; however, normal rapidly dividing cells such as the epithelial lining of the GI tract are often affected. Radiation therapy causes anorexia, stomatitis, severe diarrhea, strictures of the intestine, and pain. Radiation treatment of the head and neck region causes taste and smell disturbances, decreased salivation, and dysphagia. Nutrition management of a patient with cancer focuses on maximizing intake of nutrients and fluids. Individualize diet choices to a patient’s needs, symptoms, and situation. Use creative approaches to manage alterations in taste and smell. For example, patients with altered taste often prefer chilled foods or foods that are spicy. Encourage patients to eat small frequent meals and snacks that are nutritious and easy to digest.

Answer 59

Health care professionals not only need to be aware of factors related to food safety but also should provide patient education to reduce risks for foodborne illnesses.

Answer 60

Ensure that suction equipment is readily available in the patient room prior to feeding Position the patient in the upright position (Fowlers/high fowlers), stimulate salivation, begin with ¼ of a teaspoon, offer liquids and solids separately, observe the larynx after each food/fluid intake, feed slowly, place food in the stronger side of the mouth, Have the patient tilt the head forward/chin down Ensure you are using the appropriate food consistency (determined after the swallow study) Avoid asking the patient to speak before swallowing

Answer 61

Coughing during eating Change in voice tone or quality after swallowing Abnormal movements of the mouth, tongue, or lips Slow, weak, imprecise or uncoordinated speech Abnormal gag Delayed swallowing Incomplete oral clearance/pocketing Regurgitation

PCC-1 Exam 3 Flashcards

(85 cards)