week 9-14 Flashcards
made on 16/17th (146 cards)
1
Q
Why is it important for us to promote activity and exercise?
A
It promotes wellness & healing (prevent illness)
Helps prevent complications of existing illness
Restores optimal functioning (physical & psychological)
2
Q
when Observing older adults with limited mobility, or who are immobile what should you note?
A
Note what interventions are used (or not used)
Consider whether these interventions are working
Consider maybe what else could be done …
3
Q
When assisting with mobilisation, nurses must…?
A
understand and practice safe body mechanics (manual handling/manutention)
Due to the potential for injury to the patient & yourselfKeep yourself fit/mobile
Be aware of your own limitations
understand Risk of self injury occurs with longer hours worked
Always practice safe manual handling techniques
4
Q
how to use proper body mechanics
A
- Nurses lift a lot of equipment and bend a lot.
- Using correct techniques is essential to preserving your back.
-Remembering the importance of a wide base of support to working with your centre of gravity.
-Using the strong muscles of the body to safely lift objects
-Officially there is a ‘no lift’ policy in all healthcare facilities but, in reality, there is a lot of pressure to
(quickly) lift patients anyway.
5
Q
what types of movements are there
A
-Alignment & posture
-Joint mobility
Range of movement (ROM)
-Balance
6
Q
Types of joint movements
A
Flexion-Decreasing the angle of the joint (e.g.
bending the elbow)
Extension- Increasing the angle of the joint (e.g.
straightening the arm at the elbow)
Hyperextension-Further extension or straightening of a joint (e.g. bending the head backwards
Abduction- Movement of the bone away from the
midline of the body
Adduction- Movement of the bone towards the midline
of the body
Rotation- Movement of the bone around its central
axis
Circumduction- Movement of the distal part of the bone in a circle while the proximal end remains fixed
Eversion - Turning the sole of the foot outward by
moving the ankle joint
Inversion- Turning the sole of the foot inward by
moving the ankle joint
Pronation- Moving the bones of the forearm so that the
palm of the hand faces downward when held in front of the body
Supination- Moving the bones of the forearm so that the
palm of the hand faces upward when held in
front of the body
7
Q
Nursing diagnoses in regards to mobility example
A
From the assessment Nursing Diagnosis is/are formed
An example:
Impaired mobility due to enforced RIB R/T # pelvis
(note # = fracture not hashtag!)
8
Q
Nursing process planning example in regards to mobility
A
What is your plan for the patient (critical thinking)?
•Expected outcomes (E/Os) formed/realistic & measurable
Eg
•Patient will remain free from the complications of immobility
•Patient will return to pre-admission mobility status by … (date)
9
Q
Nursing process implementation in regards to mobilisation
A
Appropriate/prioritised interventions are implemented
•What suggestions can be made so your patient meets those E/Os above
- Nursing interventions are put into practice
- Nursing interventions must aim toward the expected outcome/s
Eg. Support devices
10
Q
Mobility support devices examples
A
Pillows
Mattresses
Chair beds
Foot care
11
Q
Examples of complications and interventions for patients with impaired mobility
A
Metabolic system changes
•Constipation/osteoperosis
Increase mobility/diet/laxatives
Respiratory system changes
•Adventitious (abnormal) breath sounds
Increase mobility/deep breathing & coughing/changing position/physio
Increase mobility/VTE prevention devices/physio/anti-thrombolytics
Cardiovascular system changes
•Orthostatic (postural) hypotension/VTE
Increase mobility/physio/ROM exercises
12
Q
Nursing process evaluation stage in regards to mobility
A
-Measure the success of the interventions
•Compare the patient’s actual response with the expected outcome
- If expected outcomes are not achieved, determine what steps must be taken
- re-evaluate your nursing interventions and your expected outcomes
13
Q
Why use fowlers positions in bed
A
Fowler’s/semi Fowler’s/high Fowler’s
•Improve ventilation/for meals
14
Q
Why use supine ( Doral rucumbent postition) in bed?
A
•Supine (Dorsal recumbent)
Spinal injuries/blood pressure issues
15
Q
Why use prone position in bed
A
•Prone
Back wounds/leg amputations/hip contractures
16
Q
Why use side lying lateral position in bed
A
•Side lying (Lateral)
Comfort/relieve sacral pressure
17
Q
Why use sims position in bed
A
•Sim’s
Comfort/relieve sacral pressure
18
Q
Why use trendelenburg position in bed
A
•Trendelenburg
Blood pressure issue
19
Q
TRANSFERRING/MOBILISING A PATIENT –
PRINCIPLES OF BODY MECHANICS
A
Self protection/responsibility •Manual handling/Manutention (as taught) •“no lift policies” •Keep yourself fit/mobile •Be aware of your own limitations •Risk of self injury occurs with longer hours worked
Know your patient (history) & their limitations
•Alignment or balance disorders
•Central nervous system damage
•Musculoskeletal trauma
- beware of confused patients ( unpredictable)
Know your patient history/Check patient’s care plan
•Encourage the patient to help as much as possible to maintain independence (& to assist you)
•Hand hygiene
- Assess the patients ability to assist you (need help?)
- Medical issues/medication issues/pain (need analgesia?)
- Patient explanation
- Patients should wear shoes and comfortable clothing
- Gather correct equipment & clear away any hazards
20
Q
If a patient has been RIB for a while what to do
A
If a patient has been RIB for a while/elevate head of bed in stages over several minutes to hours.
•Ensure the patient sits on the side of the bed and “dangles” legs for 1-2 minutes
•Deep breaths/fully oxygenate tissues/stabilises blood pressure
•After standing remain stationary for ~ 60 secs, if patient feels dizzy the bed is close by
•The patient determines the pace/but also know your patient’s limitations
•If in doubt always get assistance from another staff member
32
21
Q
When assisting in ambulatory how should you surround your load
A
Depending on your patient for safety you may need to - Surround your load (stand to the side ) one arm around their waist (so that the client’s centre of gravity remains midline), the other under the axilla (demo) – noting use of walking belts may replace this technique
- If assisting a hemiparesis (one sided weakness) patient, stand by the client’s affected side and support the client with arm around the waist and other arm around anterior aspect of the clients shoulder girdle, don’t ever pull on a hemiparetic limb (demo)
- Encourage the patient to look ahead for obstacles and to plan their path
22
Q
Body movement, activity and exersise health promotion
A
Australia has one of the greatest obesity problems on Earth
•All age groups need to increase activity (& improve diet/sedentary behaviours)
•Many opportunities for educating and promoting the health of our patients
•On discharge/everyday nursing care/child health community health/many many situations to do this
0 – 5 yr olds titled ‘Move & Play Everyday’
•Basically encouraging the child to be more active
5 – 12 yr olds titled ‘Make your move – Sit less – Be active for life!’
•Similar to previous age group (be more active) but with some age appropriate (& interesting) additions aimed to:
•To develop co-operation & teamwork
•To decreases bullying/anti-social behaviours
13 – 17 yr olds titled ‘Make your move – Sit less – Be active for life!’
•Similar to previous age group (be more active) with similar aims but with some age appropriate additions.
•Limit (non-educational) computer games & TV (120 mins per day)
18 – 64 yr olds also titled ‘Make your move – Sit less – Be active for life!’
•Similar to previous age groups (be more active) with similar aims but with more age appropriate additions.
•Activity of 30 mins per day on 5 days per week
65 yr olds & over also titled ‘Choose health: be active. A physical activity guide for older Australians’
•Similar to previous age groups (be more active) with an aim to encourage health and fitness as this group ages.
•Activity of 30 mins per day preferably 7 days per week
23
Q
health problems that limit movement/mobility:
A
Anything that affects the following body systems ;
Musculoskeletal (arthritis)
Nervous (Parkinson’s/spinal injury [paralysis]/CVA [stroke])
Cardiovascular (heart failure/angina)
Respiratory (COPD/asthma)
Vestibular apparatus (inner ear)
24
Q
assessment of mobility and body movement (adpie)
A
On admission just watch as patients walk in
- Observe!
- What is the patients range of motion/movement (ROM)/limitations
- Gait- the style of walking – rhythm/speed/balance
- Their medical diagnosis may indicate potential mobilisation issues (Parkinson’s/old CVA [‘stroke’])
- Collecting physical activity history (subjective information)
- Exercise – the type/regularity/intensity of exercise the patient does
- Conducting an examination (objective information)
-If they have been rest in bed (RIB) do they already have complications of immobility?
25
what mobilisation skills do nurses need
- Principles of Body Mechanics
- Know your patient history/check patient’s care plan
- Encourage the patient to help as much as possible to maintain independence (& to assist you)
- Conduct a ‘Risk Assessment’ of your patient
- Give patient explanation/obtain consent/set goals
- They require shoes/comfortable clothing/gather correct equipment/clear hazards
- And always remember your hand hygiene
26
what do you do when conducting a risk assessment on your patient
look at...
History of falls
Assess their ability to assist you (need help???)
Their medical issues/medication issues/pain
Are they confused unpredictable?
27
who is more likely to have a fall
Infants & older adults are more likely to have falls & suffer injuries because of them
In the older adult:
- Falls are the leading cause of injuries
- Most occur at home
- Falls are a major cause of hospital & aged care facility admission
- A fear of falling can result in a reluctance to leave the home
- Leading to social isolation & depression
-Commonly the fall occurs at home, leading to hospitalisation, & then admission to aged care facility as they cannot cope at home anymore (because of the injuries from the fall, and/or further fear of falling)
28
Falls prevention at home (in the community):
Engaging older people in falls prevention programs works best:
By encouraging exercise & balance improvement programs
By encouraging regular review of medication by a pharmacist
By having regular health assessments (most importantly regarding their vision & balance)
In home assessments to assess the need for safety improvements
By introducing vitamin D & calcium supplementation may have benefits
29
Falls prevention in hospitals (& aged care facilities)
Falls prevention in hospitals (& aged care facilities)
Engage with the patient & their family on this topic
The ‘fact sheets’ about preventing falls may be useful & appropriate as discussion points & hand-outs
Engage with the patient as to what changes they can make to decrease the chance of falls occurring
Cultural and linguistically diverse (CALD) engagement is essential
Individual assessment & (home & behaviour) modification is required
If a patient (who lives at home) is hospitalised then community (home) assessment must be included before they go home
30
when to do falls risk assessment
-Risk assessment must be initiated on admission
There are many different tools available
-Routine physio review is required for patients with mobility impairment
Like all care, falls risk prevention strategies require ongoing evaluation to assess their success.Just like the Nursing Process.If the patient has a fall, or ‘close call’ (almost a fall), the patient must be reassessed & new interventions considered
- Routine urinary assessment should be conducted to assess for UTIs
- Regular staff education in regard to prevention, screening, assessment & interventions should be conducted- Including knowledge of & access to this document
31
how to prevent falls
- Medication review by a pharmacist may be required
- Hospital staff should ensure that the environment is safe for the patient & that they are orientated in regard to:
- Bed height
- No ‘clutter’(safe mobilising)
- Toileting availability & access
- Adequate lighting
- Personal belongings’ availability (eg glasses)
- Alarm devices may be required for some wandering/confused patients
- Safe footwear is essential
32
what is urinary elimmination
Re-absorption of water & electrolytes (as part of a fine balance)
Excretion of waste
A necessary part of health & wellness
Ageing can affect urine production & elimination. As you get older – less nephrons. Possibly less urine produced.
Possibly resulting in imbalance of water & electrolytes
33
urinary elimination Changes in the older adult and nursing interventions
Changes in the older adult
Less nephrons – resulting in …?
Men – bigger prostate – urinary retention/urgency
Women – decreased bladder tone/supportive structures
Urgency & stress incontinence/ UTIs
```
Nursing implications
Medication/surgery
Bladder training
Improve access to toilet/bathroom
Timed toileting (develops habit, works well with cognitive impaired)
```
34
Changes in urinary elimination through the lifespan
Foetus -The foetal kidney begins to excrete urine between the 11th and 12th week of development.
Infant- Ability to concentrate urine is minimal; therefore, urine appears light yellow. Because of neuromuscular immaturity, voluntary urinary control is absent.
Child- Kidney function reaches maturity between the first and second year of life; urine is concentrated effectively and appears a normal amber colour. Between 18 and 24 months of age, the child starts to recognise bladder fullness and is able to hold urine beyond the urge to void. At approximately 2½ to 3 years of age, the child can perceive bladder fullness, hold urine after the urge to void and communicate the need to urinate.
Full urinary control usually occurs at age 4 or 5 years; daytime control is usually achieved by age 3 years. The
kidneys grow in proportion to overall body growth.
Adult- The kidneys reach maximum size between 35 and 40 years of age. After 50 years, the kidneys begin to diminish in size and function. Most shrinkage occurs in the cortex of the kidney as individual nephrons are lost.
Older adult -An estimated 30% of nephrons are lost by age 80. Renal blood flow decreases because of vascular changes and a decrease in cardiac output. The ability to concentrate urine declines. Bladder muscle tone diminishes, causing increased frequency of urination and nocturia (waking to urinate at night). Diminished bladder muscle tone and contractibility may lead to residual urine in the bladder after voiding, increasing the risk of bacterial growth and infection. Urinary incontinence may occur due to mobility problems or neurological impairments.
35
what is Polyuria
Excessive urination is known as polyuria
Ingestion of fluids containing caffeine or alcohol
Prescribed diuretic
Presence of thirst, dehydration and weight loss
History of diabetes mellitus, diabetes insipidus
or kidney disease
36
what is Oliguria, anuria
low urine output
Decrease in fluid intake
Signs of dehydration
Presence of hypotension, shock or heart failure
History of kidney disease
Signs of renal failure such as elevated blood
urea nitrogen (BUN) and serum creatinine,
oedema, hypertension
37
what is Frequency or nocturia
increased urination at night
Pregnancy
Increase in fluid intake
Urinary tract infection
38
what is Urgency ( urinary elimination)
Presence of psychological stress
Urinary tract infection
Neurological impairment
39
what is dysuria
Dysuria
Urinary tract inflammation, infection or injury
Hesitancy, haematuria, pyuria (pus in the urine)
and frequency
40
what is enuresis
Enuresis
Family history of enuresis
Difficult access to toilet facilities
Home stresses
41
what is inconstinence
Incontinence
Bladder inflammation or other disease or
disability
Difficulties in independent toileting (disability)
Leakage when coughing, laughing, sneezing
Neurological impairment
Cognitive impairment
42
what is retention ( urinary elimination)
Retention
Distended bladder on palpation and percussion
Associated signs, such as pubic discomfort,
restlessness, frequency and small urine volume
Recent anaesthesia
Faecal impaction
Recent perineal surgery
Presence of perineal swelling
Medications prescribed
Lack of privacy or other factors inhibiting
micturition
43
Characteristics of normal and abnormal urine
| -amount in 24 hours-
normal-
1200–1500 mL
abnormal-
Under 1200 mL
A large amount
over intake
Urinary output normally is approximately equal to fluid intake. Output of
less than 30 mL/hr may indicate decreased blood flow to the kidneys and
should be immediately reported
44
Characteristics of normal and abnormal urine
| -colour and clarity-
normal-
Straw, amber
transparent
```
abnormal-
Dark amber
Cloudy
Dark orange
Red or dark brown
Mucus plugs,
viscid, thick
```
45
Characteristics of normal and abnormal urine
| -odour-
normal-
Faint aromatic
abnormal-
Offensive
46
Characteristics of normal and abnormal urine
| -sterility-
normal-
No
abnormal-
Micro-organisms present
Urine in the bladder is sterile. Urine specimens, however, may be
contaminated by bacteria from the perineum during collection.
47
Characteristics of normal and abnormal urine
| -Ph-
normal-
pH 4.5–8
abnormal-
Over 8
Under 4.5
48
Characteristics of normal and abnormal urine
| -specific gravity-
normal -
1.010–1.025
abnormal-
Over 1.025
Under 1.010
49
Characteristics of normal and abnormal urine
| -glucose-
normal-Not present
abnormal- Present
50
Characteristics of normal and abnormal urine
| -ketone bodies (acetone)-
normal-
Not present
abnormal-
Present
51
Characteristics of normal and abnormal urine
| -blood-
normal- Not present
| abnormal-
Occult
microscopic
Bright red
52
what is faecal elimination
- Re-absorption of water & nutrition (as part of a fine balance)
- Excretion of waste
-A necessary part of health & wellness
- Ageing can affect intestinal absorption & eliminationPossibly resulting in nutritional imbalance & constipation
- Faeces also provides us with a lot of information.
53
treatment of constipation
Treatment of constipation , Increase mobility Increase fluid intake , increase fibre in diet , if these fail then a suppository can be given to help
54
normal Characteristics of faeces
Colour: brown
Consistency: soft formed
Shape: tubular as in the shape
of the rectum
Amount: the average is 100
to 200 g per day although
defecation patterns
Odour: differs subject to diet
but tolerable
Constituents: normal faecal
content
55
how often should faecal elimination be monitored
Monitoring patient regularity
Time honoured nursing responsibility
Constipation is a major hospitalisation issue. Why?
Regular charting required (traditionally with 1800 obs./documented on obs chart)
“have you been today?”/defaecated/pooed/had a crap/had a sh**
56
how to categorises stool
using the Bristol stool form scale to
describe the motion).
type 1- seperate hard lumps like nuts
type 2- sausage like but lumpy
type 3- like a sausage but with cracks on the surface
type 4- like a sausage or snake, smooth and soft
type 5- soft blobs with clear cut edges
type 6- fluffy pieces with ragged edges, a mushy stool
type 7- watery, no solid pieces
57
how might some patients require assistance with defaecation
Some patients require assistance with defaecation
Aperients & laxatives
Suppositories
Enemas
‘manuals’
-Some patients have a colostomy (or similar)
58
in order to give a suppository what must you do before
To be able to give a suppository to a patient it has to be prescribed onto the medication chart
In order to be sure you are giving the medication correctly you have to follow the 6 rights
59
what are the 6 rights
```
Right client
Right route
Right drug
Right dose
Right time
Right documentation
```
60
Procedure of giving suppository
The procedure should be fully explained to the patient to gain consent, maximise understanding and ensure co-operation.
Medicated suppositories and enemas must be prescribed before administration, and manufacturer’s guidelines should be followed.
Procedures may cause embarrassment and anxiety for the patient. Privacy is essential to maintain dignity and prevent discomfort.
A commode or bedpan should be readily available in case of rapid unexpected bowel evacuation or, if required, assistance should be provided to help the patient to the toilet.
The effects of the rectal medication must be evaluated and documented to ascertain whether further treatment is required.
61
giving a suppository guidelines
* Maintain patient privacy
* Encourage self-administration where possible
* For clarification of insertion technique refer to the manufacturer’s guidelines
* Determine if patient requests presence of a chaperone during procedure
* If so, determine gender and arrange accordingly to prevent misinterpretation of nursing actions. Refer to EMHS Chaperone Policy
Document chaperone details
* Assist the patient (as required) into the left lateral position with knees flexed. Allows ease of passage of the suppository into the rectum by following the natural anatomy of the colon, thus reducing discomfort 1,2
* Don non sterile gloves/PPE as per standard precautions
* Place a waterproof protective sheet (bluey) under patient’s buttocks (as needed)
* Lubricate all rectal medications with gel prior to insertion to reduce mucosal trauma
Suppositories
* Gently insert the suppository into the rectum, apex first for local effect or base first for systemic absorption 2
* Gently insert suppository ~ 2-4cm into rectum using index finger 1
62
what are the psycho social ageing theories for older adults
Psychosocial ageing
Havighurst - activity theory
Atchley - continuity theory
Erikson - ego integrity v despair
The importance of independence
63
Older adults cognition with aging
Perception - not as good when interpreting the environment, peripheral vision, finding things, balance
Cognition - normally lose speed not ability, memory might be less than it was loosing speed but not ability. can still learn well.
64
developmental tasks of the older adult
65 to 75 years
■ Adjusting to decreasing physical strength and health.
■ Adjusting to retirement and lower and fixed income.
■ Adjusting to the death of parents, spouses and friends.
■ Adjusting to new relationships with adult children.
■ Adjusting to leisure time.
■ Keeping active and involved.
■ Making satisfying living arrangements as ageing progresses.
75 years and older
■ Adapting to living alone.
■ Safeguarding physical and mental health.
■ Adjusting to the possibility of moving into a residential
aged care facility or supported accommodation.
■ Remaining in touch with other family members.
■ Finding meaning in life.
■ Adjusting to one’s own death.
65
what is ageism
“… a form of discrimination based solely on age”
Caused by negative attitudes/misunderstanding/ unrealistic portrayal in the media/ lack of respect (in today’s society)
Demonstrated to cause anxiety/social exclusion/ increased disability/depression
66
myths about ageism
All old people are senile.(Not a normal part of aging It is a disease process)
Old people are preoccupied with dying.(Stereotypical comment (aren’t we all …)
Old people cannot learn new skills.(Many still enjoy learning & many do adopt new skills)
Most old people live in nursing homes.(The majority live privately in the community)
Old people are not interested in sex.(Many remain very interested and are restricted in ways to express their sensuality)
Old people are a burden on society.(The majority lead productive, independent lives, caring for themselves.
Fact:- the aged conduct the majority of volunteer work )
67
how to reverse negative attitudes of ageism
Accept generational differences
The important role of the family
(can be cultural)
assisting with medical requirements
Include the older person in planned activities & also in decision making (whether family or community)
Societal respect/media respect (not stereotyping)
Expressions of care/contact/patience/listening
Empowerment
Practice person-centred care
Value their opinion & demonstrate respect
You cannot just enter their domain (‘home’) & instantly enter into a therapeutic relationship
Start simply/introduce yourself/ask permission to sit & listen with respect
Express care/patience
Appropriate communication/appropriate touch
68
on nursing prac how to respect the elderly
It’s not necessary what you do but how you do it! (with respect/care/compassion/dellivered from a wide knowledge base)
Feeding/washing/personal hygiene/toileting/listening
Be culturally aware (listen & learn/develop a knowledge base)
Observe how others treat them
wide variance in their care
learn from ‘best practice’
69
what is elder abuse
Elder abuse is a single or repeated act, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.
Abuse can include physical, sexual, financial, psychological abuse and/or neglect.
70
forms of elder abuse
Single incident to ongoing pattern
From carer stress/frustration
Family or residential carer
Physical (Active - hitting/hurting/rough treatment)
Physical (Passive – withholding of life comforts)
Psychological (name calling/threats/humiliation/shaming)
Financial (with holding money/theft)
Sexual abuse (inappropriate conversation/touching/exposure)
Neglect (failure to provide…./with holding of care)
71
risk factors of elder abuse
Physically frail and dependent people (power!)
Dementia (twice as likely to experience elder abuse)
Physically disabled people
72
indicators of elder abuse
Withdrawal/depression/isolation
Behavioural changes (fearful/anxious)
Unexplained injuries
Conflicting stories
Poor physical condition
73
elder abuse protections
Compulsory Reporting mechanism under the 2008 amendments to the 1997 Aged Care Act
Intended to protect the abused & the reportee
Only applicable to Commonwealth funded aged care facilities
Please familiarise yourself with the link in the references
This is a professional obligation
In WA – Advocare (protection, advocacy & information) is a useful resource for older adult advocacy/support
74
health promotion for older adults in regards to health screening
Health tests and screening
■ Total cholesterol and high-density lipid protein measurement
every 3 to 5 years until age 75.
■ Aspirin, 100 mg daily, if in high-risk group.
■ Diabetes mellitus screen every 3 years if in high-risk group.
■ Smoking cessation.
■ Screening mammogram every 1 to 2 years (women).
■ Clinical breast exam annually (women).
■ Pap smear annually if there is a history of abnormal smears or
previous hysterectomy for malignancy.
■ Annual digital rectal exam.
■ Annual prostate-specific antigen (PSA).
■ Annual faecal occult blood test (FOBT).
■ Sigmoidoscopy every 5 years; colonoscopy every 10 years.
■ Visual acuity screen annually.
■ Hearing screen annually.
■ Depression screen periodically.
■ Family violence screen periodically or as indicated.
■ Height and weight measurements annually.
■ Sexually transmitted disease testing if in high-risk group.
■ Annual flu vaccine if over 65 or in high-risk group.
■ Pneumococcal vaccine (23vPPV) at 65 and every 10 years
thereafter.
75
health promotion in older adults in regards to safety
Safety
■ Home safety measures to prevent falls, fire, burns, scalds and
electrocution.
■ Working smoke detectors in the home.
■ Motor vehicle safety reinforcement, especially about driving
at night.
■ Precautions to prevent pedestrian accidents.
76
health promotion in older adults in regards to nutrition and exersise
Nutrition and exercise
■ Importance of a well-balanced diet with fewer calories to
accommodate lower metabolic rate and decreased physical
activity.
■ Importance of sufficient amounts of vitamin D and calcium to
prevent osteoporosis.
■ Nutritional and exercise factors that may lead to cardiovascular
disease (e.g. obesity, cholesterol and fat intake, lack of exercise).
■ Importance of 30 minutes of moderate physical activity
daily; 20 minutes of vigorous physical activity three times
per week.
77
health promotion in older adults in regards to elimination
Elimination
■ Importance of adequate fibre in the diet, adequate exercise
and at least six to eight glasses of water daily to prevent
constipation.
78
health promotion in older adults in regards to social interaction
Social interactions
■ Encouraging intellectual and recreational pursuits.
■ Encouraging personal relationships that promote discussion
of feelings, concerns and fears.
■ Assessment of risk factors for maltreatment.
■ Availability of community centres and programs for older
citizens.
79
why do we do urinalysis and what equipment is needed
Urine is tested to screen and diagnose for kidney disorders and urinary tract infections
A sample of urine is required which is a clean catch technique
Need only about two ounces of urine to be able to test accurately
80
what does colour of urine indicate
We look at the colour if it is yellow brown to olive green there is excess bilirubin
Colourless urine could indicate diabetes insipidus
81
what does urine with an aroma of ammonia indicate
Aroma like ammonia can indicate a UTI
82
what does glucose in urine indicate
Glucose may indicate Diabetes Mellitus
83
what do ketones in urine indicate
Ketones can indicate altered Carbohydrate and fat metabolism in DM
84
what does billirubin in urine indicate
Bilirubin could indicate that there is a liver disorder
85
what does specific gravity in urine indicate
Specific Gravity indicates how well the kidneys concentrate the urine and the patients hydration status
86
what does osmolarity of urine indicate
Osmolality can indicate tubular dysfunction
87
what does pH of urine indicate
PH 4.0-8.0 (average 6.0) higher than 8 can indicate a UTI
88
what do RBC in urine indicate
RBC can indicate a calculi, cystitis, neoplasm, glomerulonephritis, TB or trauma
89
what do WBC in urine indicate
WBC again can indicate UTI
90
what is done if an abnormality shows up on the reagant dip stick
if anything shows up in the urine dipstick then a MSU would need to be sent to the laboratory for further testing
91
what are the changes to urinary elimination accross the lifespan
Foetus -The foetal kidney begins to excrete urine between the 11th and 12th week of development.
Infant- Ability to concentrate urine is minimal; therefore, urine appears light yellow. Because of neuromuscular immaturity,voluntary urinary control is absent.
Child- Kidney function reaches maturity between the first and second year of life; urine is concentrated effectively and appears a normal amber colour. Between 18 and 24 months of age, the child starts to recognise bladder fullnessand is able to hold urine beyond the urge to void. At approximately 2½ to 3 years of age, the child can perceive bladder fullness, hold urine after the urge to void and communicate the need to urinate.Full urinary control usually occurs at age 4 or 5 years; daytime control is usually achieved by age 3 years. The
kidneys grow in proportion to overall body growth.
Adult- The kidneys reach maximum size between 35 and 40 years of age. After 50 years, the kidneys begin to diminish in size and function. Most shrinkage occurs in the cortex of the kidney as individual nephrons are lost.
Older adult- An estimated 30% of nephrons are lost by age 80. Renal blood flow decreases because of vascular changes and a decrease in cardiac output. The ability to concentrate urine declines. Bladder muscle tone diminishes, causing increased frequency of urination and nocturia (waking to urinate at night). Diminished bladder muscle tone and contractibility may lead to residual urine in the bladder after voiding, increasing the risk of bacterial growth and infection. Urinary incontinence may occur due to mobility problems or neurological impairments
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how to cary out a urinalysis
Wash hands an place on gloves
Dip the dipstick to cover all the coloured pads into the urine
Start to read from glucose at the bottom
Work your way up slowly taking into account time needed for absorption
Document your results
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in a health person what is fluid balance like
In a healthy person the intake of water in food and fluids balances the out put of water in urine faeces perspiration and respiration
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what can influence fluid balance
Some things such as caffeine coco and cola drinks can affect urine production and output
Caffeine promotes increase urine formation (diuresis)
Alcohol inhibits the release of antidiuretic hormone (ADH)
This results in increased water loss in urine
Some veggies may have a high content of water which again increases urine production
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what is a fluid balance
“The balance of the imput and output of fluids in and out of the body to allow metabolic processes to function “.
The total body weight of women is 52% fluid and for men it is 60%
It is important for a nurse to access who may be in need of a 24 hr FBC
Important to be able to complete the FBC correctly
This chart is as important as filling out the medication chart correctly
If not filled out no point in doing it
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what counts as intakes of fluid
We not only look at what patients drink but also what they eat
Example soup and jelly are counted as fluids
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Average daily fluid intake for an adult
Oral fluids - 1200 to 1500
Water in foods- 1000
Water as by-product of food metabolism- 200
Total- 2400 to 2700
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Average daily fluid output for an adult
Urine- 1400 to 1500
Insensible losses....
Lungs- 350 to 400
Skin- 350 to 400
Sweat- 100
Faeces -100 to 200
Total 2300 to 2600
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Why do a FBC
In patients who are sick and especially the elderly they may not want to eat and drink which carries a risk of dehydration
The chart will help the nurse to see if the patient is being hydrated correctly
Symptoms of dehydration include
Impaired cognitive function;
Reduced physical performance;
Headaches, fatigue, sunken eyes and dry, less elastic skin (Welch, 2010).
If dehydration persists, the circulating volume of blood can drop. This leads to:
Hypotension;
Tachycardia;
Weak, thready pulse;
Cold hands and feet;
Oliguria (reduced urine output) (Large, 2005)
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when would you expect over hydration
Over hydration is less common than dehydration it is found in patients who have the following health problems;
Heart Failure
Renal impairment
Liver Disease
Oedema is seen when the interstitial fluid volume is abnormally high, however, there are cases where it is not caused by fluid overload
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what is Oedema
a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the bod.
Oedema is seen when the interstitial fluid volume is abnormally high, however, there are cases where it is not caused by fluid overload
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how to evaluate odema
Palpate for oedema over the tibia and see how far down the skin dips
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example of nursing diagnosis and plan for patient with odema
d: excess fluid retention related to history of heart failure
p: Promote fluid balance and prevention of complicationsresulting abnormal or undesired fluid levels
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example of implementation and evaluation (adpie) of patient with odema
i: assess location and extent of odema on a scale of 1-4. maintain accurate intake and outpu recod FBC. weig daily and monitor trendsa. counsel doctor if signs and symptoms of fluid excess contine
e: not compromised. 24 hrs intake and output equal stable body weight
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what to know when measuring BGL
People with diabetes need to monitor their blood glucose levels regularly to ensure they are within the desired range to help minimise the complications of having diabetes
We as nurses should ensure that the patient has the knowledge and skills to carryout this themselves
This is a lifelong health problem so they need to take control of their diabetes and manage it themselves
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when should BGL be carried out
BGLs should be carried out usually after or before the following
Before breakfast (fasting)
Before lunch/dinner
Two hours after a meal
Before bed
Before rigorous exercise
When you are feeling unwell
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blood glucose level target for type 1 diabetes
4-8 mmol/L before mmeals, <10mmol/L after starting meal
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blood glucose level target for type 2 diabetes
6-8mmol/L before meals, 6-10mmol/L after starting meal
ppl with type 2 not taking sulphonylurea medication or insulin could aim for a blood glucose as close to as normal as possible
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what is hypoglycaemia
low blood glucose.
both type 1 and 2 are at risk of it.
if less than 4mmol/L - if insulin or certain tablets are used
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what to do before taking BGL
Before completing BGL please determine the frequency needed
Check the patients understanding of the testing
Explain the procedure to reduce anxiety and stress
Gather all your equipment needed
Carry out hand hygiene and ask the patient to do this as well
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how to conduct BGL
Prepare your glucometer by turning it on and ensuring you have the correct strips for the correct machine
Don gloves
Use the sides of the adult finger as this has fewer nerve endings. Ensure that the finger is warm and that there is blood by squeezing very gently
Draw blood by placing the loaded lancet on finger and pressing the button
Place a spot of blood on the reagent strip and wait until the glucometer reads the result
Document in the notes
Most importantly teach the patient how to do it
Once blood is on reagent strip give patient a tissue to stop the blood
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What does the Registered Nurse Standards for Practice (2016) do
Provides safe, appropriate and responsive quality nursing practice.
National Competency Standards for the Registered Nurse are...
Recognises and responds appropriately to unsafe or unprofessional practice
Follows up incidents of unsafe practice to prevent recurrence
Integrates nursing and health care knowledge, skills and attitudes to provide safe and effective nursing care
Provides comprehensive, safe and effective evidence-based nursing care…
. . . performs procedures confidently and safely
Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately
. . . applies relevant principles to ensure the safe administration of therapeutic substances
. . . prioritises safety problems
. . . adheres to occupational health and safety legislation
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requirements of the RN’s registration in practicing safely is supported by what other standards:
National Safety and Quality Health Service Standards
Australian Commission for Safety and Quality in Health Care
Continuous Professional Development requirements
Australian Safety and Quality Framework for Health Care
Basically safety in nursing (and health care ) is a BIG thing
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The Australian Safety and Quality Goals for Health Care are?
Safety of care
Appropriateness of care
Partnering with people
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opportunities in healthcare for safety errors?
Falls
Medications/calculations
Miscommunications between staff/patient – staff (verbal/documentary)
Pressure area development
Misuse of equipment
Wrong patient/wrong procedure/mis-identification
Incorrect assessment
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Increasingly there are safety breaches involving staff are related to:..
Increasingly there are safety breaches involving staff, related to:
Overwork/too much overtime/unreasonable patient – nurse ratios
Nurse ‘burn-out’ often related to ‘care frustration’
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strategies in place to minimise risk to patients:
(All health professional including RN) registration requirements
Health facility (hospital/aged care) accreditation (required to meet & maintain certain standards)
Clinical governance
Structures/systems/standards to maintain safety & quality
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what is accreditation
: a status that is conferred on an organisation or a
person when they have been assessed as having met particular
standards. The two conditions for accreditation are an explicit
definition of quality (i.e. standards) and an independent review
process aimed at identifying the level of congruence between
practices and quality standards (ACSQHC 2016)
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what is Advanced Incident Management System (AIMS)
a voluntary reporting system of incidents that occur in the health care workplace
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what is Clinical governance:
structures, systems and standards applying to create a culture and direct clinical activities. Clinical
accountability and responsibility, a subset of clinical governance, involves the monitoring and oversight of clinical activities, including regulation, audit, assurance and compliance by
governors (such as boards of directors), regulators (such as governments, professional bodies) and internal and external auditors (Brennan & Flynn 2013)
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what are critical incidences
unintended consequences of an action or
actions that may result in harm to recipients of care or staff involved in care delivery. Critical incidents can, for example, also involve staff being exposed to violence in the workplace or to activities that result in needle-stick injuries: becoming distracted when giving intravenous injections, vaccinating children/
babies, disposing of used needle and syringe incorrectly.
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what is Incident reporting
the system or process for reporting incidents in the health care workplace.
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what are Mandatory competencies
competencies the nurse must be
| able to demonstrate continuously in the health care workplace.
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what is Patient safety management
processes and systems of work used by nurses to minimise harm to patients and to themselves
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what is Risk management
a series of processes developed to minimise
harm to people and staff working in health care organisations.
Risk management also applies to staff—providing staff with safe
systems of work.
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what is a Root cause analysis
: a process used for investigating and categorising unintended consequences of health care professionals’ actions during the course of their work.
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what are sentinel events
the unintended consequences of health professionals’ activities that can result in serious or even fatal injury
to people receiving care. Sentinel events may also involve staff
in incidents that result in psychological injury as well as physical
injury.
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what is Staff safety
organisational and professional systems of work
| designed to minimise harm to staff.
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what is Work health and safety
national legislation that regulates and
| supports safe work practices in all workplaces.
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Factors affecting safety?
Age & development
Lifestyle
Mobility & health status
Sensory-perceptual/communication impairments
Cognitive awareness
Emotional state
Safety awareness
Environmental factors
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safety hazards throughout the lifespan
■ Developing foetus: exposure to maternal smoking, alcohol
consumption, addictive drugs, x-rays (first trimester), gestational diabetes, mental health issues, certain pesticides.
■ Newborns and infants: falling, suffocation in bassinet, choking from aspirated milk or ingested objects, burns from hot water or other spilled hot liquids, motor vehicle accidents, cot or playpen injuries, electric shock, poisonings, harm
from other people and animals.
■ Toddlers: physical trauma from falling, banging into objects, getting cut by sharp objects, motor vehicle accidents,
burns, poisoning, drowning and electric shock, harm from other people and animals.
■ Preschoolers: injury from traffic, playground equipment and
other objects; choking, suffocation, airway or ear canal
obstruction with foreign objects; poisoning, drowning, fire and burns; harm from other people and animals.
■ Adolescents: vehicular (motor vehicle, motor bikes, bicycles) accidents, recreational accidents, firearms and other weapons, substance abuse, mental illness.
■ Older adults: falling, burns, pedestrian and vehicular accidents, harm from other people and animals.
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factors affecting safety; lifestyle
Unsafe home environment (crime/home safety)
Unsafe work environment
Risk-taking behaviours (adolescents/young [male] adults)
Self-medication poisoning
Self-harm
Falls
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groups most at risks of hospitalised injury
over 65+ aged ppl
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major causes of injury
transport, falls,
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factors affecting safety: mobility issues
From mobility impairment
From balance problems
And interventions to minimise the chance of these occurring..
- Risk assessment
- Individual strategies
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factors affecting safety:: sensory perceptual impairments
```
Sensory perceptual impairments, such as:
Vision
Auditory (hearing)
Olfactory (smell)
Touch
Results in potential safety problems
```
There are strategies to assist many people at home who have sensory perceptual problems
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factors affecting safety: cognitive awareness
```
Cognitive impairment may mean:
Affected by drugs (alcohol/prescription/non-prescription) Sleep deprived
Disoriented/confused
Brain injured
Congenital disorders
```
This cognitive impairment may affect the person’s ability to perceive their environment safely:
Driving/crossing the road/fire safety/cooking dangers
The list of potential safety problems are endless
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factors affecting safety:emotional state ( anxiety and depression)
Emotional state (examples are anxiety & depression)
Extreme emotional states increases stress & can affect cognitive awareness & render a person:
Unable to think clearly or concentrate
More likely to make errors in judgment
Prone to slow reaction times
All which can lead to potential safety problems
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factors affecting safety:Ability to communicate
Ability to communicate
Some people because of disease, injury or congenital malformation struggle to communicate; including:
Aphasia – strictly means no speech
Dysphasia – difficulty with speech
Language barriers
Literacy difficulties
These difficulties with communication may result in people mis-reading safety signs, educational advice
If offering written advice enquire whether the person understands what you are giving them
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factors affecting safety:Safety awareness
Covers a wide variety of considerations such as:
Water awareness
Fire awareness
Chemical awareness
Bush fire awareness
But also:
Call bells
Road safety
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factors affecting safety: Environmental factors
```
Nurses have a responsibility to admit & care for their patients in safety, regardless of:
Age
Disability
Sexuality
Culture & ethnicity
```
As part of our professional requirement to care for our patients in safety there have been a number of strategies put in place over the years:-
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priority patient education promoting safety for Newborns and infants:
Properly fitted car capsules & child car seats
Checking bath water and formula temperature
Safe cots, toys, no small parts
Electrical safety
Poisons etc out of reach of small children
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priority patient education promoting safety for toddlers
Properly child car seats
Checking bath water temperature/water safety
Safe toys, no small parts
Electrical safety
Poisons etc out of reach of small children
Pool safety
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priority patient education promoting safety for preschoolers
Preschoolers:
Road safety
Pool/water safety
Fire safety
‘Stranger danger’
Playing safely
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priority patient education promoting safety for School age children/ adolescents
School age children/adolescents:
Similar to preschoolers +
Sports safety
Safe use of equipment (cooking, tool work)
Dangers of drugs, alcohol, cigarettes, gambling
Road safety (scooters, bicycles)
Safe sex
Importance of maintaining open communication
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priority patient education promoting safety for young adults and middle aged adults
Young adults:
- As before (road safety, dangers of drugs …)
- Safe & healthy lifestyle behaviours
```
Middle-age/older adults:
As before
Implementing safety measures due to changes in:
Vision
Balance
Elimination
Cognitive ability
```
