CRRN Test 1

L2

Mid anterior thigh

Maslow presented confidence, achievement, respect of others and respected by others as examples of which need

Esteem

Sleep deprivation causes

Psychosis

Functional Incontinence

Pt is aware he needs to void due to dementia altimerz / need to remove environmental barriers

How often should clients be repositioned in bed to maintain skin integrity?

Q 2 hours

How often should clients be repositioned in a chair to maintain skin integrity?

Q15 minutes

The cure for Autonomic Dysreflexia is

Quickly assess the stimulus causing the hyperreflexia, then alleviate the cause. i.e., over distended bladder-catherize, fecal impaction-manually disimpact, decubitus ulcer-alleviate pressure, restrictive shoes or clothes-loosen.

What are the two separate stages in the sleep cycle?

REM (rapid eye movement) & NREM (non-rapid eye movement)

You dream the most during

REM (rapid eye movement) cycle

Semantic language or substantive word stage is at what age?

18 - 36 months

What year did Clara Barton form the red cross

1877

1 st rehab act was formed in what year

1920

Vocational rehab act was formed in what year

1943

Alice Morrissey first book of rehab was formed

1951

Medicaid was Enacted in what year

1965

Medicare began with the SSA in what year

1965

ANA published first guidelines on the need for rehab nursing in what year forming CARF

1966

Rehab Act

1973

When was Association of Rehab nursing started?

1974

Balance Budget Act

1997 -which required pps( is prospective payment system) required used of resource utlization groups (RUGS)

Eyes open to verbal command

3

Flexes abnormally (Decorticate Posturing) (Motor Response)

3

Uses inappropriate words (Verbal Response)

3

A client at this Rancho Los Amigos level will respond to discomfort by pulling tubes or restraints, is inconsistent in responses to simple commands, and may respond to some people (family friends) but not others.

3 localized response

Female puberty begins at what age?

8 to11

how likely is it that you will have a recurrance after a TIA within a year?

80%

ischemic stroke

87% of strokes, vessel occulsion where focal areas of the brain receive diminshed or no blood supply

American Nurse's Association Code of Ethics has ____ provisions

9

Male puberty begins at what age?

9 - 15

A client at this Rancho Los Amigos level is able to shift back and forth between tasks and completes them independently for at least 2 consecutive hours. Uses assistive memory devices to recall daily schedules and "to do" lists. Initiates and carries out steps to complete familiar personal, household, work and leisure tasks with assistance when requested.

9 Purposeful, appropriate: standby assistance

Diarrhea, dependent edema, diuretics, diabetes insipidus, wound exudate, excessive sweating are all causes of?

Extracellular fluid loss

Where do most stokes lesions occur

Middle cerebral artery

Which drug classes can suppress desire and sexual function?

SSRI's, tranquilzers, tricyclic antidepressants, diuretics, antihistamines, narcotics, street drugs, horrmones, H2 antagonists

Untreated dehydration/hypovolemia progresses to what?

Shock

Metformin

Shuts off the liver glucose production

A multifaceted concept that includes instrumental support, affective support, and cognitive support.

Social support

The enrichment of the patient's life through interactions with family, friends, and society

Support System Enhancement - have friends visit, peer support groups

Initial recognition of pain and temp

Thalamus

Pleasant vs unpleasant feelings

Thalamus

Relay Station

Thalamus

What act required all public buildings and transportation be made accessible to all. Which also prohibits discrimination against people with disabilities in the workplace.

The Americans with Disabilities Act of 1990.

What prohibits employment discrimination against qualified people with disabilities in the private sector and in state and local governments.

The Americans with Disability Act (ADA)

What prohibits employment discrimination base on race, color, religion, sex or national origin?

The Civil Rights Act of 1964

What act defined the term " developmental disability"

The Developmental Disablities Assistance and Bill of Rights Act of 2000

The purpose of energetic touch is to remove

blockages in the energy field to promote healing.

Affective support as part of social support includes

concern, being loved, feeling important and support presence

muscular dystrophy

genetic disesases that cause degeneration of muscle fibers

cystic fibrosis

genetic disese that affect exocrine glands

cystic fibrosis

genetic disorder of the exocrine gland that produces abnormal thick mucus

middle child hood 6-12 years old

give child task to do to help lead to sense of accomplishment and purpose allow contact to see peers

Consolidated Omnibus Budget reconcilation Act

gives people in specific categories the right to continue health coverage for up to 18 months after they quite or have been fired

The goal of rehab nursing

" assisting the individual with a disability or a chronic disease toward maximal health through health restoration, maintenance, and promotion.

What is a mechanical embolus clot removal and in what time period must it be done?

"cork screw" removal of a embolus must be done 8 hours post onset

A state in which an individual or family experiences a natural human response involving psychosocial and physiologic reactions to actual or perceived loss is termed

"grief associated with disability"

Rehabilitation definition

"the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems relative toaltered funtional ability and lifestyle." (ARN, 2000, pg4)

Rehab nursing is defined as

'the diagnsosis and treatment of human responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle"

State the defining characteristics of Ineffective Family Therapeutic Regimen Management

- Acceleration of family member's illness symptoms - Failure to take action to reduce risk factors - Participation in inappropriate family activities for meeting health goals - Lack of attention to illness - Verbalization of difficulties with therapeutic regimen

Websites for health information should be evaluated using the following criteria:

- Accuracy - Authority - Objectivity - Currency - Coverage

What are the risk factors for Risk of Falls?

- Age (adults age 65 and older) - history of falls, - lower limb prosthesis, - use of assistive devices, - impaired sensation or perception (temperature, touch, positive sense, vision and hearing), - unmet elimination need or urinary incontinence, - use of chemical or physical restraints, - environmental hazards, - lack of knowledge related to safety, and - impaired mobility

Assessment for ineffective health maintenance depends on which client aspects?

- Client's self-management abilities and knowledge - emotional and spiritual state, and - social support system

What are the defining characteristics of Ineffective Community Therapeutic Regiment Management?

- Deficits of advocates for the aggregates, - deficits in community activities for prevention, and - insufficient healthcare resources

State some of the nursing interventions for Ineffective Family Therapeutic Regimen Management.

- Determine the types of equipment, supplies, and services that are lacking. - Identify who in the client's support system is willing to develop the strategies necessary to improve management of therapeutic regimen - Foster the client's advocate in promoting the client's wellness and health management - Educate the client and the client's primary advocate on their learning level

State some of the interventions for ineffective health maintenance.

- Educate the client at their learning level - Determine readiness to learn - Use memory aids - Help the client identify and begin to resume family role responsibilities - Identify adaptation strategies - Assist client and family develop stress management skills

In what ways can the rehabilitation nurse promote good nutrition to patients?

- Helping the client understand the importance of diet and encouraging dietary compliance; - assisting those who need help with the eating process; - taking and recording client weight and calorie counts: - observing clinical signs of poor nutrition and reporting them; - serving as a communication link between the client, dietician, physician, and other members of the healthcare team.

State the nursing roles in community-based rehabilitation settings.

- Partner - Educator - Planner - Coordinator - Resource manager - Evaluator of client outcomes - Client advocator

Name the five core self-management concepts around which outcomes and interventions are developed to promote self-efficacy in the Health Promotion Model.

- Problem solving - Decision making - Resource use - Collaboration - Action

List some interventions that should be incorporated wen feeding a dysphagia client.

- Seat client upright (preferably 90 degrees) - minimize distractions (such as no TV or talking) - select appropriate food consistency and texture and progress to less restrictive measures as appropriate. - place food on the unaffected side of the mouth, small bites, chin tuck, head turn, or fluids by spoon or cup only. - tongue sweep, double swallow, small sips of water between bites, adaptive equipment for self-feeding, and remain upright for 20-30 minutes after eating a meal.

What are the diagnostic tests/data that help in determining a client's nutritional status?

- The serum albumin indicates available protein stores - Hemoglobin indicates the ability to transport oxygen - Glycohemoglobin (hemoglobin A1C) indicates average blood glucose during the last 3 months - Prealbumin level indicates nutritional status, protein synthesis and catabolism

What are unmodifiable risk factors for stroke?

- age - being male is greater likelihood - having had a previous stroke or TIA (BEST PREDICTOR) - family history

How to put advocacy in action?

- assessment - planning and - implementation

What factors affect the artery walls putting them at a greater risk of stroke?

- atherosclerotic plaques - dissecting walls - damage leading to pressure on the walls, leading to rupture - congenital abnormalities

How do you diagnose dysphagia?

- bedside assessment - video fluoroscopic swallow study - endoscopic evaluation of swallowing - other signs (pocketing, leakage, delayed or prolonged swallowing, frequent pneumonia, malnutrition, and weight loss)

What are the benefits of client education?

- better outcomes for client and family - improved client and family satisfaction - continuity of care - cost containment and, - improved staff satisfaction

What is a lacunar infarction

- blocks vessels going to deep brain centers - leads to vascular cognitive impairment

4 preventative measures of recurrent stroke?

- exercise - anticoagulants - lipid lowering agents - lifestyle change

What are interventions that can be used to maintain skin integrity?

- good nutritional support - use supplement if needed (protein or calorie malnutrition inhibits wound healing by reducing fibroblast and collagen synthesis). - manage tissue loads by repositioning every 2 hours in bed and weight shift every 15 minutes in chair. - Cushion bony prominence, provide adequate support, avoid placing the client on an existing ulcer, protect skin from friction and shearing, elevate heels off the mattress, and maintain the head of bed at or below 30 degrees unless contraindicated. - other inventions: overhead trapeze for increased bed mobility and appropriate pressure redistribution mattress.

What are the modifiable risk factors of stroke?

- hypertension - CVD - DIabetes - Cholesterol - Smoking - Obesity - cocaine use - oral contraceptives (with smoking - may cause hemorage strokes)

what venous factors pose a risk of stroke?

- inflammation of the inner lining - slow blood flow - poor return, inactivity - DVT - inactivity, surgery, damage

Causes of dysphagia?

- radiation treatment - stroke, - worsening dementia, - myasthenia gravis and - amyotropic lateral sclerosis (ALS)

What are the 5 sypmtoms of a brain attack?

- sudden dizziness/ balance issues - sudden visual problems - sudden disturbance of speech - sudden numbness or weakness of the face, arm or leg (on one side of the body)

hospitalized/rehab of toddler of 1-3yrs old

-distressed child since can not follow routine sleep, eating and may regress -loss of control is frightening -seperation anxiety, lack of time perception,coping mechanism may be lost

significance of family on rehab

-needs of the family can be anticipated depending on the stage of family -caution when nurses assess and assist nontraditional families -support from families influence feelings of well-being when attachment promote security

Anomia

...

If a stroke is ignored the prognosis is worse

...

Piaget's sensorimotor stage of development occurs at what age?

0-2 years of age

measurement in key muscle

0=total paralysis 5=normal active movmement

No motor response (Flaccid Coma) (Motor Response)

1

No response (Eye Opening)

1

No response (Verbal Response)

1

motor/sensory paralytic neurogenic

1 disruption of sacral reflex in cord at s-2,3,4 2. causes-trauma, tumors,diabetic neuropathy,ms-sensory 3.absent bulbocavernous 4, males have problem starting stream, need to strain, overflow incontinence 5. absent saddle sensation 6. variable sensation 7. lack of pain, fullness, temp, lrg voids, overflow

Olfactory

1 or I smell

Put in correct order for extracellular fluid deficit process: Rise in Serum Sodium Level, Kidneys Retain Water, Increased concentration of dilutes in blood, Loss of Body Fluids, Increased Water Intake, H2O molecules shift out of cells, Thirst

1)Loss of Body Fluids 2)Increased concentration of dilutes in blood 3)Rise in Serum Sodium Level 4)H2O molecules shift out of cells 5)Kidneys retain water 6)Thirst 7)Increased water intake

Elderly are at risk for dehydration because?

1)Lower body/water content 2)decreasing kidney function 3)Diminished ability to sense thirst

Name 3-4 strategies to address Uninhibited Neurogenic Bowel

1)avoiding constipation 2)insuring an adequate intake of fluids and fiber (bulk) 3)facilitating adequate exercise 4)weaning from bowel medications if possible 5)using bathroom schedule based on the pt's usual time of defecation 6)using suppositories or mini enemas to stimulate emptying at a predictable time, if bathroom scheduling is ineffective 7)making sure it is easy for the pt to get to the bathroom in a timely manner

Features of Uninhibited Neurogenic Bowel are:

1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal or hyperactive bulbocavernous reflex 4)sudden defecation with or without urgency 5)hard stool with smearing

Name 3-4 features of Uninhibited Neurogenic Bladder

1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal to hyperactive bulbocavernous reflex 4)sudden voiding with our without urgency, frequency or nocturia 5)decreased bladder capacity

Name 3-4 strategies for Uninhibited Neurogenic Bladder.

1)maintain adequate fluid intake, but avoid exceeding 2000ml/24 hrs 2)decrease fluid intake early in the evening to avoid nocturia 3)use timed voiding, prompted voiding or habit training to increase continence based on the pt's cognitive abilities 4)use bathroom schedules based on the pt's usual time of voiding 5)use anticholinergic meds to decrease detrusor contractility and to increase bladder capacity 6)make sure it is easy for pt to get to the bathroom in a timely manner

Common interventions for constipation in rehab are:

1)manage causative factors (diet, fluids, exercise) 2)utilize gastrocolic reflex to stimulate emptying 3)encourage regular evacuation time 4)place on toilet instead of bed pan

Lab values in untreated hypovolemia/dehydration may indicate what?

1)normal to elevated serum sodium levels (varies w/ the amt of fluid and sodium loss) 2)increased or normal hematocrit levels 3)elevated blood urea nitrogen levels 4)elevated urine specific gravity

Name 3 interventions for functional incontinence

1)respond promptly to requests to void 2)alter clothing and provide adaptive equipment 3)remove environmental barriers

Gilligan's theory

1,individuals define themselves in terms of their ability to from meaningful relationships 2,define themselves in terms of their ability to care for others 3. responsiveness to others in the context of their situation and their own terms

The most common pain assessment tool is

1-10 pain intensity scale, where 1 is barely any pain and 10 is the worst pain ever.

What is the time period for sparing a stroke victim?

1-3 hours - if taken to the hospital within this time period they may receive TPA

Rehab Nursing standards of Care

1. Collection of comprehensive data pertinent to pt.'s health 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation of pt. progress

Standards of professional performance

1. Evaluation of quality of care 2. performance appraisal/ internal evaluation as related to standards and regulations 3. Education, maintaining current knowledge and competency 4. Collegiality 5. Ethics and Advocacy 6. Collaboration with patient, family,& other healthcare providers in providing care 7. Research 8. Resource Utilization 9. Leadership

How does the nurse assess for Risk for Injury?

1. Identifying factors that affect safety needs such as - changes in mental status, - fatigue, - medications, and - motor or sensory deficits 2. Identify environmental factors that create risk for falls; check the client for presence of constrictive clothing, cuts, burns, or bruises.

goals and intervention for MS

1. Improve mobility and NIM fuction 2. Conserve Energy 3. Maintain indep in ADL 4. Improve bladder function and prevent complication 5. improve knowledge

diabetes oral meds

1. Sulfonlureas stimulate insulin prodcution(glyburide,glipazide,glimperide) 2, Biguanides-decrease hepatic glucose production (metformin) 3. Alpha Glucosidase inhib-slow carb/sugar absorption(migiitrol,acarbose) 4.Thiazolidinediones increase insulin sensitivity(Actos) 5. Meglitinides -stimulate insulin production (repaglinide) 6. Dipeptidyl pepidase-improve insulin syntheisis

Social Learning Theories

1. Trust vs mistrust (birth to 1 year) 2. Autonomy vs Shame (1-2 years) 3. Initiative vs Guilt (3-5 years) 4.Industry vs Inferiority (6-12) 5. Intimacy vs Isolation 6. Generativity vs Stagination 7. Integrity vs Despair

Nolan and Nolan described 6 roles of the rehab nurse

1. assessment of patient's physical condition and delivery of needed care 2. Teach and counsel patient 3. be sensitive to and understand patient moods and coping mechanisms 4. Understand family dynamics, 5. deal with issues related to sexuality6. health care liason role and knowledge in health care delivery systems.

areflexic neurogenic

1. damage to pns below L1 2. loss of sphincter control flaccid 3,trauma, spin bifida, herinated disc 4. absent saddle and bulbcavernaus sensation 5. overflow incontinence,weak sensation of fullness 6 stool leakage 7. hard stool impactions

reflex neurogenic

1. disruption of cns system 2. loss if coertica and voluntary spincter 3. damage to umn above t12 4.resulting from trauma, tumor,infection, infarct,MS 5. absent saddle sensation 6.hyperactive bulbcavenous 7. high residual, external reflex will not relax 8. rare sudden incontience due to full rectal vault

long term planning : community services for children and youth

1. school program-IDEA-Individual with disabilites education Act-ensures that all children 3-21 receive free and appropriate public education 2. early intervention services 3. home health care when neede from birth to 3 years old

unhibited neurogenic

1. disrutpion of inhibitory fiber in the brain 2. impaired cortica awareness of urge 3. stroke, tbi, ms, tumore 4. damage to upper motor neuron 5, intact : saddle nerve reflex,intact bulbocavernous 6. uncontrolled voiding, smaller volumes, nocturia, urgency, frequency 7. sudden incontience, hard stool with smearing

criteria for diagnostic of diaberes

1. hbA1c greater than 6.5 2. non-fasting b/s greater than or =200mg/dl 3. Fasting bs greater than 126 4. 2 hr glucose tolerance greater than 200

What are the two types of stroke?

1. ischemic (thrombus, embolic, lacunar) 2. hemoragic (aneurysm, A-V malformation)

Nursing Theory can be viewed as tree with roots and branches

1. metaparadigm of person, environment, health, and nursing represents the roots 2. Florence Nightingale's work froms the trunk of the tree 3. Branches are shaped by 3 theory types interactive-Henderson and Peplau Systems-Neuman and Roy Development-Rogers,Leininger and Watson

s/s of stroke

1. numbness or wekness/paralysis in face/arm or leg 2. sudden confusion, trouble speaking, or understanding 3. trouble seeing 4. sudden ataxia,dizziness, loss of balance 5. sudden severe headache

types of pulmonary diseases

1. obstructive lung disease 2. restrictive lung disease

What are the six weighted elements in the Braden scale to determine the pressure ulcer risk?

1. sensory (ability to respond meaningfully to pressure-related discomfort) 2. moisture (degree to which skin is exposed to moisture) 3. activity (degree of physical activity) 4. mobility (ability to change and control body position) 5. nutrition (usual food intake), and 6. friction and shear (stability of movement in a relaxed position, such as in a bed or chair) The total risk status of the client is determined according to the sum of all the elements on the scale

types of spina bifida

1. spina bifida occult-mildest form posterior lamina does not fuse 2. menigocele-herniation contains no neural tissue 3. myelmeningocele-lesion contains spinal fluid,meinges,spinal nerves and possibly spinal cord.

s/s of MI

1.crushing,squeesing,stabbing chest pain 2, radiation of discomfort down one or both arms or back 3.neck,jaw,teeth pain 4.epigastric pain,n/v 5diaphoresis,weakness,apprehension,lightheadedness,syncope,dyspnea and pallor 6.htn,hypotension

medications for chd

1.diuretics-lasix,hctz,burmex 2,Ace inhibitors-reduce blood volume(captopril,monopril) 3.Arbs-dilate great veins(vasotec,avapro,diovan,cozar 4.calicum channel blockers-reduce blood volume(Norvac,Procardia,Veraparmil) 5.alpha-blockers-dilate vessels-(cardura,hytin,clondine)

gate control theory on pain

1.gating mechanism in spinal cord 2.travel via large A-delta or small c-fibers to spinal cords 3.cells of substantia gelatinosa are gate keeper 4.Large A-delta fibers close the gate 5.Small C-fibers open the gate

4 parts of growth and development for children

1.physical -move and manipulate environment 2. cognitive-communication and solve problems 3. social-establish relationship 4. psychological-develop a sense of awareness,self-image and self confidence

A client with this Rancho Los Amigos level is able to handle multiple tasks simultaneously in all environments but may require periodic breaks. Is able to independently procure, create, and maintain own assistive memory devices. Independentley initiates and carries out all steps to complete familiar and unfamiliar personal, household, community, work, and leisure tasks, but may require more than reasonable time to complete them.

10 Purposeful, appropriate: modified independent.

A client with this Rancho Los Amigos level anticipates impact of impairments and disabilities on ability to complete daily living tasks and takes action to avoid problems before they occur but may require more than usual amount of time and or compensatory strategies to select the appropriate action. Social interaction behavior is consistently appropriate.

10 Purposeful, appropriate; Modified independent.

Vagus

10 or X swallowing, voice production, heart rate, rate of peristalsis, sensation in throat, thoracic and abdominal viscera

Peripheral Nervous System

11 cranial nerves except CNII, peripheral nerves, connects cns to organs and muscles, no protective coating

Spinal Accessory

11 or XI shoulder and head movement

At what age does Piaget's Formal Operational Stage of development occur?

11-15 years of age

Hypoglossaal

12 or XII tongue movement

On average how much sleep does an 8 month old infant get?

13 hours a day.

The Functional Measurement tool (FIM) is a numeric measure of

13 motor and 5 cognitive functions.

What amendment to the US constitution guarantee the right to die and to decline medical treatment?

14th amendment

Full consciousness receives what score?

15

Extends abnormally (Decerebrate Posturing) (Motor Response)

2

Eyes open to pain

2

Makes incomprehensible sounds (Verbal Response)

2

Optic

2 or II vision

Piaget's Preoperational Stage of development occurs at what age?

2-7 years of age

What percent of stroke victims become permanently disabled?

20%30%

A patient with dysphagia should remain upright (preferably 90 degrees) during the meal and for how long afterwards?

20-30- minutes.

How long do the deficits of a TIA last?

24 hours

At this Rancho Los Amigos score the client's responses are directly related to the type of stimulus, they demonstrate withdrawal or vocalization to painful stimuli, will turn towards auditory stimuli, and blink when strong light enters the visual field.

3 localized response

Oculomotor

3 or III eye movement eyes moving in and out, constricting pupils, accommodating for light

First screening Swallow test

3 ounces of water

How likely is it that you will have a significant stroke within a month after a TIA?

30%

A client is alert with a heightened state of activity. Purposeful attempts to remove restraints or tube or get out of bed. This client can sit, reach and walk but without apparent purpose or upon another person's request....What is his Rancho Los Amigos score?

4

Disoriented/Confused, converses (Verbal Response)

4

Flexes and withdraws from pain (Motor Response)

4

Spontaneous Eye Opening

4

Vygotsky theorical framework

4 basic principles 1. children construct their knowledge. 2. development cannot be seperated from social context 3. learning leads to development 4. language has a major role in mental development

This client has absent short term memory, may cry out or scream out of proportion to stimulus even after the stimuli are removed. May exhibit aggressive or flight behavior. Mood shifts are common from euphoric to hostile with no apparent relationship to environmental events. What is the Rancho Los Amigos score?

4 confused and agitated

This client is unable to cooperate with treatment efforts, makes frequent verbalizations that are incoherent and/or inappropriate to activity and environment. What is the Rancho Los Amigos score?

4 confused and agitated

Trochlear

4 or IV eye movement down and outward.

Emotional lability

Characterized by uncontrollable, fluctuating emotional behaviors (Gaiety, somberness and crying)

How many stages of NREM (non-rapid eye movement) sleep are there and in what stages of NREM sleep do respirations decrease?

4, respirations begin to decrease in the second stage and continues through stages 3 & 4.

Oriented, converses (Verbal Response)

5

To localized pain (Motor Response)

5

A client at this Rancho Los Amigos level is able to respond appropriately to simple commands fairly consistently with external structure and cues. Verbalizations about present events become inappropriate and confabulatory when external structure and cues are not provided.

5 Confused, inappropriate non agitated; maximum assistance.

A client at this Rancho Los Amigos level is alert, not agitated, but may wander randomly or with a vague intention of going home. May become agitated in response to external stimulation and or lack of environmental structure.

5 Confused, inappropriate non agitated; maximum assistance.

A client at this Rancho Los Amigos level is not oriented to person place or time. They demonstrate a severely impaired recent memory, with confusion of past and present in reaction to ongoing activity. This individual is absent goal-directed, problem solving, self monitoring behavior.

5 Confused, inappropriate non agitated; maximum assistance.

A client at this Rancho Los Amigos level often demonstrates inappropriate use of objects without external direction. May be able to previously learned tasks when structured and cues provided. They are unable to learn new information.

5 Confused, inappropriate non agitated; maximum assistance.

Trigeminal

5 or IV chewing, sensations of the face, scalp and teeth

What % of stroke victims recover?

50%

Obeys Verbal Commands (Motor Response)

6

A client at this Rancho Los Amigos level can demonstrate an emerging awareness of appropriate response to self, family, and basic needs. Needs moderate assist to problem solve barriers to task completion. Is supervised for old learning and shows carryover for relearned familiar tasks (e.g., self care).

6 Confused but appropriate needing moderate assistance.

A client at this Rancho Los Amigos level can demonstrate more depth and detail to remote memories than recent memories, has vague recognition of staff, is able to use assistive memory aid with maximum assistance.

6 Confused but appropriate needing moderate assistance.

A client at this Rancho Los Amigos level is inconsistently oriented to person, time and place. They are able to attend to highly familiar tasks in non distracting environments for 30 minutes with moderate redirection.

6 Confused but appropriate needing moderate assistance.

A client at this Rancho Los Amigos level needs maximum assistance for new learning with little or no carryover. Unaware of impairments, disabilities and safety risks. Consistently follows simple directions, and verbal responses are appropriate in highly familiar and structured situations.

6 Confused but appropriate needing moderate assistance.

Abducens

6 or VI outward eye movements

Home plans must be established and reviewed by a physician every _____ days

60

What % of stroke victims require institutional care?What age group does stroke mostly affect?

65+

Requirements for medicare

65, receiving SS for 24 months or those with chronic diseases requiring dialysis or a transplant.These patient are not required to wait the 24 months .

A client with this Rancho Los Amigos level has a superficial awareness of his/her conditin but is unaware of specific impairments and disabilitiesand the limits they place on his/her ability to safely, accurately, and completely carry out his/her household, community, work and leisure ADLs. They are unable to think about consequences of a decision or action. Overestimate abilities, and can be oppositional and uncooperative.

7 Automatic, appropriate: minimal assistance.

A client with this Rancho Los Amigos level is consistently oriented to person & place within highly familiar environments. Requires moderate assistance to orient to time. Is able to attend to highly familiar tasks in a nondistraction environment for at least 30 minutes with minimal assist to complete the tasks.

7 Automatic, appropriate: minimal assistance.

A client with this Rancho Los Amigos level requires minimal supervision for new learning, initiates and carries out steps to complete familiar personal and household routines, but has shallow recall of what he/she has been doing.

7 Automatic, appropriate: minimal assistance.

Facial

7 or VII facial expression, taste, salivation, crying

A comatose client would receive what score?

7 or less

Piaget's Concrete Operational stage of development occurs at what age?

7-11 years of age

A client at this Rancho Los Amigos level is able to record critical information for later use with standby assist, they are able to initiate and carry out steps to complete familiar personal, household, community, work, and leisure routines with standby assist and can modify the plan when needed with minimal assistance.

8 Purposeful, appropriate; standby assist.

A client at this Rancho Los Amigos level is consistently oriented to person, place, and time. Independently attends to and completes familiar tasks for 1 hour in distracting environments and is able to recall and integrate past and recent events. They use assistive memory devices to recall daily schedule and "to do" lists.

8 Purposeful, appropriate; standby assist.

A client with this Rancho Los Amigos level requires no assistance once new tasks or activities are learned. they are aware of and acknowledge impairments and disabilities when they interfere with task completion.

8 Purposeful, appropriate; standby assist.

At what age can an infant understand a few words and has partially intelligible speech?

8 months to 1 year

Acoustic

8 or VIII hearing and equilibrium

Duvalls Life Cycle

8 stage division that allows differential of the family cjamges ad individuals development 1.marriage and the joining of the families 2.families with infants 3. families with preschool-age children 4.families with school-age children 5.families with teenagers 6.families as launching center 7.families of middle years(empty nest) 8. families in retirement

A client at this Rancho Los Amigos level is aware of and acknowledges impairments and disabilities when they interfere with task completionand takes appropriate corrective actions. Acknowledges others' needs and feelings and responds appropriately with standby assistance. Depression may continue. May be irritable and have a low frustration tolerance.

9 Purposeful, appropriate: standby assistance

Glossopharyngeal

9 or IX secretes saliva, swallowing, controls gag reflex, sensation in the throat, and taste

What % of risk factors for stroke are modifiable?

90

Handicap

A disadvantage for a given individual resulting from impairment or disability that limits or prevents fulfillment of a role that is normal for that individual. (Societal level)

Developmental task

A growth responsibility that arises at a certain time in the course of development

What is Wellness?

A journey that each of us takes in our quest for a well-bein of body mind & spirit. Key component s include personal responsibility, body-mind-spirit connectedness; and relationships with self, others, and the environment (Miller 2008)

medical home concept

A medical home is not a building , or hospital, but rather an approach to providing health care services in a high-quality and cost effective manner

Interdisciplinary model

A model in which communication is lateral. Effective when team members are stable (in patient rehab unit). Decision determined by group.

Rehabillitation is

A philosophy An attitude An approach

Definition of Rehabilitation

A process of helping a person to reach the fullest physical, psychological,social, vocational,avocational and educational potential consistent with his/hers physical or anatomic impairment,environmental limitation and desires and life plans.

Disability

A restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. (Level of person)

Self efficacy

A sense of control that is composed of coping with appraising and managing one's life (ex: if I don't believe I can do it I likely will not be able to do it)

What is Health?

A state of complete physical, mental, and social well being and not merely the absence of disease of infirmity (WHO, 1948)

Urge incontinence is characterized by

A strong urge to void, frequency, and nocturia.

The oral preparatory phase of swallowing

A voluntary action where food is prepared, smelled and then salivation occurs. Food is put into the mouth manipulated to form a bolus and then pushed posterior toward the oropharynx.

The oral phase of swallowing

A voluntary action where the tongue is elevated to the roof of the mouth. Lips close to contain oral contents. Buccal and facial tone are necessary for chewing.

Hormone involved in regulation of intracellular fluids. Produced by pituitary gland. Stimulates reabsorption of fluids. Secretion of it increases when blood is concentrated like in dehydration.

ADH Antidiuretic Hormone

Stage Three of Neal's Home Health Theory

AFter approximately two years, the nurse moves into this stage and feels autonomous with regard to logistical and clinical aspects of community centered nursing

Nursing process for cardiac pts

APIE-Assessment,Plan including goals, Implement(interventions), Evaluation

Complete injury without preservation of sensation or motor function in S4-5.

ASIA-A

Incomplete injury with preservation of sensation throughout the cord, including S4-5.

ASIA-B

Incomplete injury with motor function intact below the level of the lesion, though the muscle strength is a grade 2 or lower, functional gain may not be significant due to weakness.

ASIA-C

Incomplete injury with motor function intact below the level of the lesion, muscle strength is a grade 3 or higher, functional gains are usually significant.

ASIA-D

Normal motor and sensory function.

ASIA-E

Above T12 - L1 Injury

Absence of sensation and voluntary control

Defining characteristics of Ineffective Family Therapeutic Regimen Management include:

Acceleration of family member's illness symptoms, Failure to take action to reduce risk factors, Participation in inappropriate family activities for meeting health goals, lack of attention to illness, verbalization of difficulties with therapeutic regimen.

How do you evaluate community accessibility?

Access the transportation for medical care, pharmacy, grocery store, and recreation - Access the outpatient and community services - Limitations and barriers of the home and community - Funding for attendant care - Independent living arrangements

Community accessibility refers to

Access to transportation, outpatient and community services, funding for attendant care, independent living arrangements, and limitations and barriers in the home or community.

Name the 5 crucial types of quality measurements according to the National Quality Measures Clearinghouse

Access, evaluation of effect, ability to provide suitiable care such as nurse to patient ratio, health care process, patient experience

Health information websites should be evaluated based on:

Accuracy, authority , objectivity, currency, and coverage.

Rem Sleep

Acetylcholine and Norepinepherine

Setting-centered care

Actue, long-term, outpatient, home care and community, A newer category of setting-focused is subacute care provides rehab for those requiring substantial medical care and who are slower to progress. (usually inpatient)

Setting Centered Care

Acute Care, Long Term Care,Out Patient Care, focused on where care is taking place,

This type of pain stems from tissue damage, is rapid in onset, and protective in nature

Acute pain

This type of pain varies from mild to severe, but should resolve when the underlying cause is resolved.

Acute pain

Roy Theory

Adaptation Model ,Goals are mutually defined , Family highly involved.

What is essential to maintain health, strength, endurance, and cognitive functioning?

Adequate and restful sleep.

Briefly explain the importance of nutrition particularly for people with disability or chronic interest.

Adequate nutrition and hydration are vital for the proper functioning of all the systems in the body. They provide the strength, energy, and endurance clients need to participate in therapeutic exercises and relearn daily activities. The goal for a rehabilitation client is to have adequate nutritional intake to support healing and meet metabolic demands. and to modify the diet as needed during acute and chronic illness or disability.

What is a document that indicates a person' s preference and medical treatment plan if he becomes incapacitated?

Advanced Directive

Delayed development

Advancement through the normal sequence of milestones at a rate slower than that of peers of the same chronological age

What type of nerve root loss or damage results in Sensory Paralytic bowel impairment?

Afferent nerve root loss or damage subsequent to diabetes mellitus or tabes dorsalis.

WHat are the ABCDs of Risk for stroke?

Age (1 point > 60) Blood pressure (1 point >140, or >90) Clinical Features (2 points - hemiparesis, 1 point - speech issues) Duration (2points > 60 mins, 1 point < 60 mins)

What are the risk factors for "Risk for Falls"

Age (greater than 65), history of falls, lower limb prosthesis, use of assistive devices, impaired sensation or perception (temperature, touch, positive sense, vision, and hearing), unmet elimination need or urinary incontinence, use of chemical or physical restraints, environmental hazards, lack of knowledge related to safety and impaired mobility.

At what age can children able to understand syntax

Age 3

According to Abraham Maslow what are the four most important physiological human needs?

Air, water, food, and sex.

One of the major hormones involved in regulation of extracellular fluids. Promotes reabsorption of water (water follows sodium). Assists in maintenance of blood volume and pressure.

Aldosterone

The FIM (Functional independence measure) should be scored & filled out by...

All interdisciplinary team members.

Sensory Paralytic bowel impairment is defined as

An absent ability to distinguish the the need or time of defecation but rarely produces incontinence because the motor function of the rectum is intact.

Which cranial nerves are involved in the swallowing process?

CN I CN V CN VII CN IX CN X CN XI CN XII

What is evidenced based practice?

An effort to integrate teh best research evidence with the client's expertise, the client's values (preferences), and the need to provide high quality and cost effective health care.

Insufficient healthcare resources, deficits in community activities for prevention, and deficits of advocates for the aggregates indicate....

An ineffective Community Therapeutic Regiment Management.

The pharyngeal phase of swallowing

An involuntary event that carries the bolus by swallowing reflex through the pharynx. The soft palate and uvula are elevated to close the nasal pharynx. The hyoid and larynx are elevated so food is less likely to enter the trachea.

The esophageal phase of swallowing

An involuntary event where the bolus enters the stomach via peristalsis and gravity. The lower esophageal sphincter opens.

Knowles learning theory

Andragogy and pedagogy

Which part of neuroanatomy relates visual impressions to the spoken word?

Angular gyrus located at the temporoparietal occipital intersection

This age-specific nursing theory is helpful when practicing rehabilitation across the lifespan.

Anne Casey's Model for children and families.

Any type of linguistic deficit precipitated by brain damage

Aphasia

Functional communication problems that can affect sexual relationships include

Aphasia or dysarthria, concrete functioning and disinhibition or impulse control.

Guardianship

Appointment have decision-maker for persons who is incapacitated

What act mandates adherence to accessiblity standards in federally financed housing?

Architectural Barriers Act

Nursing assessment to transition to community for the eldery

As a rehab nurse: concerns are resp status, motor function,altered sensory issues,nutrition, bowel/bladder, focus on ability, quality of life not longevity.

Lydia Hall's theory

Aspects of Nursing are Core, Care and Cure

Sleep promotes healing and endurance, what should rehabilitation nurses do to promote sleep?

Assess disruptions in client's sleep and apply specific interventions to restore restful sleep patterns.

Nursing interventions for bowel management programs include

Assess prior level of function, and adapt the program to accommodate the previous routine. Increase fluid, bulk, and fiber intake. Monitor bowel sounds and abdominal distention. Avoid gas causing foods. Encourage sitting up on toilet to promote defecation reather than bedpans, provide appropriate medications such as softeners, laxatives, suppositories, or enemas. Encourage loose clothing and good hygiene.

Nursing interventions for bladder management programs include

Assess prior level of function, provide adequate lighting for clients with nocturia. Timed voiding to prevent incontinence. Assess medications that contribute to incontinence (diuretics, sedatives, anticholinergics, or antihypertensives). Provide adequate hydration.

When assessing for ineffective health maintenance...

Assess the client's self-management abilities and knowledge, emotional and spiritual state, and social support system .

Durable power of attorney

Assign another person to act on the patient behalf

1974

Association of Rehabilitation Nurses was created

Health Belief Model

Attempts to explain differences among individuals

The most basic level of language which includes routine responses such as prayers or curse words is called

Automatic language

The basic idea and timeframe of Erik Erikson's second stage of psychosocial development is

Autonomy vs shame and doubt (toddlerhood). Understanding control over one's body and thinking. Understanding disappointment in self and others.

Nurses must be able to provide educational materials regarding sexuality and reproduction after disability. These should include

Available methods and aids to enhance sexual expression and contraception.

Name 4-5 common interventions for dehydration

Avoiding hypertonic IV solutions, encouraging increased oral fluid intake, administering salt-free fluids, supplementing with D5W, administer fluids slowly to avoid cellular edema, monitoring vitals, tracking I & O's, monitoring weight, monitoring lab results, maintaining integrity of skin and mucous membranes are interventions for what?

Grab bars, shower chairs or bath seats, and wash mitts are adaptive devices for

Bathing and hygiene.

Functional Mobility assessments include

Bed mobility transfers, wheelchair mobility, and ambulation.

Dysphagia is diagnosed by

Bedside assessment, video fluoroscopic swallow study, or endoscopic evaluation of swallowing.

External locus of control

Belief that one's life is controlled by feet, chance, events or other people

Internal locus of control

Believe that outcomes are influenced by one's choices and actions. Use more problem-solving approaches to cope

Benefits of client education include:

Better outcomes for client and family, improved client and family satisfaction, continuity of care, cost containment, and improved staff satisfaction.

Potential effects of bladder dysfunction problems as related to sexual relationships include

Bladder accidents decrease the appeal of sexual activity, presence of foley catheter may hinder sexual activity, and presence of urostomy may hinder sexual enjoyment.

Learning domains

Bloom

A person's subjective picture of his or her own appearance that is based on observations, comparisons, and reactions by others

Body image

Which sexual position is best for people at risk for MI?

Bottom position and heart rate should be monitored for about a quarter hour after intercourse

Which sexual position is best for spasticity due to spinal cord injuries?

Bottom position due to lack of control

Potential effects of bowel dysfunction problems as related to sexual relationships include

Bowel accidents decrease the appeal of sexual activity, and presence of a colostomy or ileostomy may hinder sexual activity.

Which tool should be used in the nursing assessment of pressure ulcer risk?

Braden Scale

Central Nervous System

Brain and Spine

Ascending and descending tracts go through

Brain stem

Contains respiratory control center

Brain stem

Cranial nerves arise from here

Brain stem

Which part of the brain is responsible for maintenance of arousal?

Brainstem, paricularly the hypothalmic-pituitary axis

An example of Expressive aphasia is

Broca's aphasia

Individuals who do not have fluent speech, and impaired ability to read, write, repeat, and name objects have what type of aphasia?

Broca's aphasia

Learning a second language would utilize which brain region?

Broca's area

Which spinal cord injury syndrome causes paralysis and loss of position sense on the same side as the injury and loss of pain and temperature sensations on the opposite side?

Brown-Sequard syndrome

How is Martha Rogers Adaptation Model used in rehabilitation therapy?

By transmitting nursing knowledge, therapeutic touch and hands on education teaching the client to adapt and live as they wish.

Reflex neurogenic Bladder

C8-T1 injury / absent voluntary control / sensation /

Lydia Hall's theory shows three interrelated parts. What are they?

Care, Core, Cure

A bladder scanner should be used to assess post void residuals (PVR). At what PVR should you catheterize?

Catheterize for PVR >150ml generally or greater than 300ml if unable to void.

Three of the main regulatory bodies for health care quality are

Centers for Medicare and Medicaid (CMS), The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP)

This type of pain is initiated or caused by a primary lesion or dysfunction in the central nervous system.

Central neuropathic pain.

Kurt Lewin

Change is both a function of personality and environment there are 3 stages of change : unfreezing ,movement, refreezing.

Factors that increase a client's "Risk for Injury"

Changes in mental status, fatigue, medications, and motor or sensory deficits.

What are 5 changes that occur in the older adult that affect bowel function?

Changes in striated and smooth muscle strength, less activity, less consumption of roughage and poorer dentition, self limiting hydration due to concerns of urinary incontinence or nocturia, and comorbidities begin with increased medication use.

This type of pain occurs when acute pain persists beyond the expected healing period, or may be present without noticeable past injury.

Chronic pain

The periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss.

Chronic sorrow

What Ranchos Los Amigos Scale would someone be if they demonstrate a generalized reflex response to painful stimuli?

Cognitive level II, generalized response

What Ranchos Los Amigos Scale would someone be if when stimulated they have generalized gross body movement, and or no purposeful vocalization? Responses may significantly delayed.

Cognitive level II, generalized response

What level Ranchos Los Amigos Scale would an individual be who responds the same regardless of type and location of stimulation?

Cognitive level II, generalized response

Bloom learning theory

Cognitive, affective and psychomotor

CIRRIE, Center of National Rehabilitation Research Information and exchange

Collects research information

Does not respond to continuous or painful stimulus; no movement except for reflex actions and does not verbalize.

Coma

Katherine Kolcaba (1990)

Comfort Theory

Home health agencies are accredited through which agencies

Community Health Accreditation Program or Home Care Accreditation Program (associated with Joint Commission)

The development of a mutually beneficial relationship between the patient who has trouble relating and health care workers

Complex relationship building - goal to establish rapport

Trial and error are replaced by the ability to problem solve in this stage of Piaget's developmental theory

Concrete operational stage of development

Watson learning theory

Conditioning or reinforcement of behaviors motivation. Repetitive learning

Caregivers who provide care only when necessary and encourage the patient to participate in decisions are considered what type of caregiver?

Conflicted

Pt's with diabetes insipidus and the elderly are at risk of dehydration. Who else is at risk?

Confused or dependent patients, pt's with dysphagia, any other on highly concentrated enteral feelings without supplemental water.

1)manage causative factors (diet, fluids, exercise) 2)utilize gastrocolic reflex to stimulate emptying 3)encourage regular evacuation time 4)place on toilet instead of bed pan Common interventions for what?

Constipation

Common bowel elimination problem in rehab is:

Constipation due to decreased fluid intake, diet and decreased mobility

Maintaining a regular program of passive range of motion (ROM) & stretching, splinting and proper positioning, and avoiding static positions can help minimize _________

Contractures.

The process of dealing with difficult problems or situations is

Coping

The method of helping the patient to adapt to stressors, changes, or threats to his lifestyle

Coping enhancement

This spinal accessory nerve innervates the skeletal muscles of the soft palate, pharynx and sensory impulses from taste buds of the poset

Cranial Nerve XI

This cranial nerve transmits sensation of smell to olfactory area of the cerebral cortex.

Cranial nerve I

This cranial nerve innervates muscles of mastication and sensory impulses from teeth, gums and lips.

Cranial nerve V also called the trigeminal nerve.

This Facial nerve receives sense of taste from anterior two thirds of the tongue and provides sensation of the oropharynx.

Cranial nerve VII

This nerve causes a motor innervation of the muscles of the tongue necessary for food manipulation, swallowing, and speech.

Cranial nerve XII

Obstructive "C-BABE

Cystic fibrois Bronchitis Asthma Bronchiectasis Emphysema

Dysarthria

D

Brown-Sequard Syndrom

Damage to one side of spinal cord

What symptom is a lacunar stroke strongly associated with?

Decreased cognition

Frequent causes of constipation in rehab pt's is:

Decreased fluid intake, diet, decreased mobility, pain meds

Martha Rogers

Defines integrality as the concept that humans and the environment are intertwined and irreducible

Dorothea Orem

Defines people outside the healthcare system upon whom the client may depend to meet self care demands as "dependent care agents"

Avoiding hypertonic IV solutions, encouraging increased oral fluid intake, administering salt-free fluids, supplementing with D5W, administer fluids slowly to avoid cellular edema, monitoring vitals, tracking I & O's, monitoring weight, monitoring lab results, maintaining integrity of skin and mucous membranes are interventions for what?

Dehydration

Isotonic fluids IV, vasopressors to raise blood pressure-both may be needed for what?

Dehydration

Lab values: 1)normal to elevated serum sodium levels (varies w/ the amt of fluid and sodium loss) 2)increased or normal hematocrit levels 3)elevated blood urea nitrogen levels 4)elevated urine specific gravity Signs of what?

Dehydration

Pt's with diabetes insipidus are at risk for?

Dehydration because brain fails to secrete ADH resulting in excessive diuresis. Easy to miss because they will have plentiful dilute urine (instead of decreased urine) until situation is advanced.

Deterioration in mental status, thirst, tachycardia, longer capillary refill times, orthostatic hypotension, dropping urine output, cool pale skin on arms and legs, rapid weight loss are s/s of what?

Dehydration/hypovolemia

Stage One of Neals Home Health Theory

Dependence on others for help with clinical and logistical aspects of community centered care

3-D's

Depression delirium and dementia none of these are normal aging we treat and manage them

Name 3-4 s/s of dehydration

Deterioration in mental status, thirst, tachycardia, longer capillary refill times, orthostatic hypotension, dropping urine output, cool pale skin on arms and legs, rapid weight loss are s/s of what?

Pt's with dehydration/hypovolemia will demonstrate the following signs and symptoms

Deterioration in mental status, thirst, tachycardia, longer capillary refill times, orthostatic hypotension, dropping urine output, cool pale skin on arms and legs, rapid weight loss.

Nursing Interventions for Ineffective Family Therapeutic Regiment Management include:

Determine the supplies and services that are lacking, Identify the client's support system and who in it can improve the management of the therapeutic regimen, foster the advocate to promote the client's wellness and health management, and educate at the client and advocates learning level.

Medical conditions that represent an increased risk factor for loss of skin integrity include

Diabetes, peripheral vascular disease, peripheral neuropathies,

C4

Diaphragm

Name 5 nursing diagnosis related to a patient's sprituality

Difficulty making decisions, dysfunctional grieving, hopelessness, spiritual distress, readiness for enhanced spiritual well-being

WHO classification in 1980 of a restriction or lack resulting from impairment, inability to perform activity in manner within normal range.Occurs at the individual level Ex-neuropathy -

Disability

Deviant development

Disruption in the normal development sequence secondary to unevenly developed or neurologically impaired process

Caregivers who make the person being cared for primarily responsible for his own care and decisions are what type of care giver?

Distanced

Which nursing theorist views the person as a biological, symbolic, and social unit?

Dorothea Orem

Which nursing theorist wrote the "self-care theory"?

Dorothea Orem's theory is known as the self care theory. The three related parts of this theory include the theory of self care, theory of self care deficit, and the theory of nursing system.

L5

Dorsal of foot

Long handled shoe horns, reachers, and velcro closures are adaptive devices for

Dressing

Part D

Drugs

family development and function theoris

Duvall's Stages of Family Development Family LIfe Cycle Theory by Stevenson

Autonomous, areflexic, flaccid, or atonal bowel disorders involves

Dysfunction in the Lower Motor Neurons (LMN), there is no cortical control, lack of tone in the internal and external sphincters with frequent oozing of stool, caused by damage to the reflexic arc.

Reflexic neurogenic bowel disorder related to spinal cord injury involves

Dysfunction in the Upper Motor Neuron (UMN), the bowel is capable of reflexive emptying of the rectum without cortical awareness of the need to defecate.

1975

Education Of all Handicapped Children

What act required states to provide education free of cost to any school-aged child

Education for all handicapped Children Act of 1975

What type of nerve root loss or damage results in Motor Paralytic bowel impairment?

Efferent nerve root loss and damage subsequent to poliomyelitis, intervertebral disc disease, tumor or trauma.

theories of aging from Erickson's

Ego vs despair Developmental tasks:to gain the ability to find meaning in old age and to accept death as part of life

The U.S. Equal Employment Opportunity Commision enforces laws related to

Employment discrimination against a person with a disability

Name the 2 issues that address the Title I of ADA

Employments State and local governmental programs and services - forbids discrimination in providing public benefit and services ,,, ,

American with Disabilities ACT

Enacted in 1990 has 5 titles of legislation that oversee the accommodations to disability needed for Employment (Title I), Public Services (Title II), Public accommodations and services operated by private entities (Title III), Telecommunications (Title IV), and miscellaneous provisions (Title V).

Nursing interventions for "grief associated with disability" include

Encourage the client and family to seek psychological counseling, help the client build a support network, help the client cultivate a positive realistic outlook. Allow time for adjustment.

Interventions to promote social support for a disabled client include

Encouraging problem-and emotion- focused coping skills; social networking, social roles for identity, power, adn family position. Encourage the client to engage in meaningful, rewarding activities and attend support group meetings.

Caregivers who deliver care skillfully and supportively are considered what type of caregiver?

Engaged

What is utilitarian ethics

Ethics of consequences - concentrating on the outcome perceived to be good

What is EBP?

Evidence-based practice Research creates the foundation for evidence-based practice, EBP promotes the use of the best current evidence in important day-to-day patient care.

A way of getting information about the most up-to-date practice into the hands of the clinicians. Founded in research, that promotes the use of the best current evidence in important day to day patient care.

Evidenced based practice.

Myasthenia Gravis

Excessive muscle fatigue

CN VII

Facial nerve receives sense of taste from anterior two-thirds of tongue. Provides sensation of oropharynx

What act prohibitis inequities related to any type of housing?

Fair Housing Act

This therapy modality is often utilized with military personnel returning from war with traumatic brain injury (TBI)

Family Focused therapy

Name some after effects of post traumatic stress disorder (PTSD)

Fear of failure, lack of resources, lack of support, role loss or ambiguity.

Neurogenic bladder

Fecreased capacity and involuntary voiding as soon as urge is perceived.

weighted utensils, built up handles, plate guards are all examples of adaptive devices for

Feeding

Clients experiencing post traumatic stress disorder (PTSD) may re-experience the event in one or more of the following ways:

Flashbacks, nightmares, excessive verbalization of the event, survival guilt, self blame, shame, fear of repetition, anger outbursts, psychological or emotional numbness, and alteration in lifestyle.

Which nursing theorist encouraged the use of one's own powers?

Florence Nightingale believed that nurses help clients obtain the best condition possible so nature can cure.

Development proceeds from logical, concrete thought to logical solutions to all kinds of categories of problems during this stage of Piaget's developmental theory

Formal Operational stage of development.

OSEP, Office of Special Education Programs

Foster r/t special education, vocational training, and research

Stevenson's Family Life Cycle

Four stages 1.The emerging Family (1-10) 2.the crystallizing family (11-24) 3.The integrating family (26-40) 4. The actualizing family (more than 40 years)

intrapyschic theories

Freud 4 phases 1.oral phase-(first year) exploring the world 2.anal phase-(18months to 3 years)-build up and release of tension in the orifices 3.Phallic phase-(3-6 years) 4. latent &mental phase(6-12yrs old)-learns social rules while experiencing sexual gratification

Name 4 standardized tools for measurement of quality

Functional Independence Measure (FIM), Minimum Data Set (MDS), Medicare Outcomes Trust health status questionnaires, Rating scales, Outcome and Assessment Information Set (OASIS)

Interventions for what problem: 1)respond promptly to requests to void 2)alter clothing and provide adaptive equipment 3)remove environmental barriers

Functional incontinence

Occurs when functional impairments limit the person's ability to use facilities in a timely or effective manner

Functional incontinence

This type of incontinence is often associated with cognitive impairment, or loss of ability to perform needed toileting behaviors independently.

Functional incontinence.

moderate brain injury

GCS 9-12 abn CT coma lasting <24hrs

Physiological signs of stress include

GI distress, cardiac palpatations, anxious facial expressions, or tremors.

The basic idea and timeframe of Erik Erikson's seventh stage of psychosocial development is

Generativity vs stagnation (middle adulthood). Being creative and productive. Carrying out parental responsibilities.

Marked incapacity to comprehend verbal and written language or write

Global or total aphasia

CN IX

Glosspharyngeal nerve sends motor impulses to the muscles of the pharynx and sensory impulses from taste buds of posterior one-third of toungue

King Theory

Goal attainment

Barnum (1998) divided (nursing) theories into those that describe and those that explain nursing phenomena.

Grand theories provide the broadest scope and present general concepts and prepositions. Middle-range theories offer concepts and prepositions at a lesser level of abstraction.

Weaning a person off a ventilator

Graudually with periods of complete rest on the ventilator.

A long handled comb is an adaptive device for

Grooming

WHO classification in 1980 disadvantage of a given person resulting from impairment or disability that limits or prevents fulfillment of a role that is normal for a human being. Occurs at the society level ex-amputation

Handicap

Inherent ability to withstand adversity

Hardiness

The process of making it easier for a person to develop a positive outlook

Hope instillation

The internal and conscious process of releasing negative attitudes and patterns and reestablishment of a feeling of wholeness

Healing

Neuman Theory

Health Care System Model :Physical,social/cultural,psychological,spiritual

What is health?

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1948).

What is the difference between health and wellness?

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1948). Wellness is a journey that each of us takes in our quest for well-being of body, mind, and spirit. Key components include - personal responsibility - balance through all phases of health - body-mind-spirit connectedness and, - relationships with self, others, and the environment (Miller, 2008). Wellness is a choice to assume responsibility for the quality of your life. It begins with a conscious decision to shape a healthy lifestyle.

Imogene King's model is about goal attainment. The goal of nursing is to ________.

Help individuals to maintain their health so they can function in their roles.

Theory of health treatment that incorporates physical, psychological, and social aspects to achieve health and well-being.

Holism

Faith in improvement

Hope

A sustained subjective emotional state in which a person sees not alternatives or personal choices available to solve problems or to achieve what is desired and cannot mobilize energy on his or her own behalf to establish goals.

Hopelessness.

Part A medicare

Hospitals, SNF's,Homehealth, hospics and is automatic at age 65 and financed by SS

Name the 3 issues in Title II of of the Americans with Disabilities Act

Housing, Education, Travel and transportation

What are effective tools for diffusing tension and grief momentarily?

Humor and laughter

Signs and symptoms of Autonomic dysreflexia include

Hypertension 20-40 mm hg above baseline, bradycardia, flushing, perspiration above the level of injury, gooseflesh (pimply state of the skin with the hairs erect) above the level of the lesion, nasal congestion, and an impending sense of doom.

CN XII

Hypoglossal nerve causes a motor innervation of te muscles of the tongue, allowing for coordinated contraction of the tongue muscles necessary for food manipulation, swallowing, and speech.

Contains Satiety Center

Hypothalamus

Controls vegetative functions

Hypothalamus

Pituitary gland

Hypothalamus

Secretion of ADH

Hypothalamus

Secretion of several hormones

Hypothalamus

Thirst and hunger

Hypothalamus

prepartion

I am getting ready

The basic idea and timeframe of Erik Erikson's fifth stage of psychosocial development is

Identity vs role confusion (adolescence). Clarifying personal identity. Depersonifying internal representations.

Dynamic life experiences and adjustment to stress

Imogene King's definition of health

Which nursing model shows that individuals are in constant interaction with their environment and one another?

Imogene King's open system model.

WHO classification in 1980 which is the loss or abnormal of a pyschological or antomical sructure and function. Ex- organ

Impairment

R Side stroke

Impulsive behavior / spatial deficts / L visual defects

Agnosia

Inability to process specific senses:difficulty distinguishing doorbell and phone ring

1990 American Disability Act

Increased accessibility, increased opportunity for employment,education and healthcare

C7

Index and middle finger

Team

Individual and family

Which act allows children with disabilities appropriate education, transition services, assistive technology, and rehab counseling?

Individuals with Disabilities Education Act

The basic idea and timeframe of Erik Erikson's fourth stage of psychosocial development is

Industry vs inferiority (school age) Dealing with latency, school, and family relationships outside the family.

What is the right to information about treatments and procedures before he/she gives permission for them?

Informed Consent

T12

Inguinal ligament

The basic idea and timeframe of Erik Erikson's third stage of psychosocial development is

Initiative vs guilt (preschool years) Dealing with predominantly genital issues.

Brown-Sequard Spinal Injury

Injury to one side of cord

Piaget's Sensorimotor stage of development states that feelings and actions are

Inseparable.

Lewis learning theory

Insight provides as a guide, model behavior, demonstrations

What are IADLs?

Instrumental activities of daily living include meal preparation, housekeeping, financial management, and transportation.

The basic idea and timeframe of Erik Erikson's eighth stage of psychosocial development is

Integrity vs despair (older adulthoood) Feeling a sense of completeness based on an integrated philosophy of one's unique life.

Which artery commonly accumulates atherosclerotic plaques?

Internal Carotid

W.H.O. Classification

International classification of -impairment -disability -handicap

The basic idea and timeframe of Erik Erikson's sixth stage of psychosocial development is

Intimacy versus isolation (young adulthood). Rediscovering attachment. Developing mature bonding.

S/S dehydration to look for?

Irritability and confusion, dizziness, weight loss, thirst, fever, poor skin turgor, decreased urine output

S3

Ischial tuberosity

Briefly describe the Frazier water protocol.

It allows clients with dysphagia to drink water 30 minutes before and after meals. The rationale is that small amounts of water even when aspirated, do not contribute to aspiration pneumonia, provided the client practices good oral hygiene before drinking each time. The 30 minutes allows the client to swallow completely and clear the oral cavity of food residues. Medications are administered whole or crushed with a spoonful of applesauce, pudding, yogurt, or thickened liquid, never with thin water. Additional compensatory measures may be recommended such as chin tuck, head turn, or fluids by spoon or cup only.

Melatonin is produced in the pineal gland, what is its purpose?

It has a role in regulating the sleep-wake cycle.

What is included in successful rehabilitation nursing?

It includes the transfer of knowledge and accountability for healthcare needs from nurses to clients and their families in a manner that promotes health and wellness for the person with a disability. Strategies are best conceived when developed in a nursing theory framework that provides education and training to address weaknesses and maximize strengths to meet the needs of clients and families to promote health in the community.

What is a nursing theory?

It is a body of knowledge used for nursing practice.

Explain the Health Promotion Model theory.

It is a nursing theory by Dr. Nola Pender that assumes that people seek to regulate their own behavior and that health professionals play an influential role throughout their client's lifespan. The personal belief in one's own capacity to control life events is a tenet of the theory.

What is evidence based practice?

It is an effort to integrate the best research evidence with the client's expertise, the client's values (preferences), and the need to provide high-quality and cost-effective health care. It is a way of getting information about the most up-to-date practice into the hands of the clinicians.

What is dysphagia?

It is swallowing difficulty during the passage of a solid or liquid bolus from the mouth to the stomach.

Define health promotion.

It is the process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment.

What is the Oral Preparatory phase of swallowing?

It is the voluntary action. Food is prepared, smelled, and the salvation occurs. Food is put in the mouth, manipulated to form a bolus, and pushed posterior toward the oropharynx.

Discuss what the Braden scale is used for and each component of the scale.

It is used to determine the pressure ulcer risk and consists of six weighted elements.

Explain the role of The Americans with Disability Act (ADA).

It protects the 54 million Americans with physical or mental impairments that limit their daily activities, such as working, walking, talking, seeing, hearing, or caring for oneself.

S1

Lateral heel

These exercises can be taught to clients experiencing stress incontinence.

Kegel, pelvic floor exercises.

Adult learning

Knowles

levels of moral development

Kohlbery 1.Preconvential-obedience/punishment 2.Convential Good- good boy/girl society 3. Post-conventional- social contract and principles

moral theories

Kohlbery theories Gilligan theories

severe brain injury

LOC >days, months, years GCS<8 permanent residul deficits

Assessment of your patients when monitoring fluid regulation should include?

Lab values, weight, vital signs, breath sounds, fluid intake, elimination patterns

C5

Lateral side of antecubital fossa

Public Law 94-142

Law passed in 1970 for disabiled children to receive educaion through mainstream or inclusion. Includes yearly IEP-Individual Education Plan Includes Head Start program

Damage to Substantia Nigra

Leads to parkinson like gait and movement

Rogers learning theory

Learner formulates own objectives, South motivated, learning contracts

Cognitive theories are closely related to

Learning and Behavioral theories.

Drowsy state, Pt can awaken, but not completely to stimulation, may also follow commands but his responses may be slow and inattentive

Lethargy

Cognitive

Lewin

Contains Amygdala and Hippicampus

Limbic System

Fight/flight response

Limbic System

Interprets sensory messages

Limbic System

Memory

Limbic System

Capped Medicare Part B

Limit for theraphy,PT and speech share same cap, OT own cap and must be medically necessary

A legal document for medical decision in case he or she become incapable to make decision

Living will

Lydia Hall

Loeb Center in NY, Nurse-run center. Three interlocking circles represent Hall's theory: the person "core", the body "care", and the disease "the cure". Different types of care in each circle. She believe people achieve their maximum potential through learning; however, because people behave according to their feeling, inattention to the person while teaching will not change their behavior. Learning within limitations. (Learning and motiviation)

What are settings for provision of Community-Based Rehabilitation nursing concepts?

Long term care facilities Subacute centers Outpatient programs Community and faith-based organizations and private homes

The settings for the provision of Community-based rehabilitation nursing include:

Long term care facilities, subacute centers, outpatient programs, community and faith based organizations, and private homes.

Estate planning

Long-term planning of the use of resources for future care and expenses

Anosmia

Loss of smell

Flaccid bladder (failure to empty urine) is often associated with

Lower Motor Neuron spinal cord injuries.

What artery is the most common site for stroke?

MCA

Effects of aging (heart)

MI, CHF, arrhythmia, peripheral vascular disease, orthostatic hypotension

A process of cost containment in which non-medical administrators such as insurance companies dictate the provision of services and medications

Managed care

What are the mandates of the Rehabilitation Act of 1973?

Mandate affirmative action and nondiscriminatin regarding employment in executive branch federal agencies

1973 Rehab Act

Mandated affirmative action and nondiscrimination regarding employment with Federal agencies

Carefully assess to determine which bowel problem you are dealing with because?

Many elderly may present with both constipation and uninhibited neurogenic problems.

Which nursing theorist views health as a value-laden term imposed by society?

Martha Rogers

Defines health as a value laden term imposed by society

Martha Rogers "definition" of health

Provider-Center Care

Maximizes use of human resource, tasks are divided

L3

Medial femoral condyle

L4

Medial malleolus

Reimbursement for homecare is primarily paid through

Medicare Part A

The utilization of any resources, people, or events in the patient's setting that can enhance psychosocial functioning

Milieu Therapy

Part C

Miscellaneous i.e ESRD

additional tmt for MS

Mitoxantrone -supressing the activity of Tcells and B cells STERIOD-shortens the duration of acute attacks BACLOFEN_treats spasms and tremors

Collaborative model

Model for provision of services that is assumed in all rehab models

Rogers Theory

Model of Science of Unitary Human Beings (Patient and Environment)

Roper Theory

Model's for living and Nursing and Gordon's Functional Health Patterns. Based on the ability to form ADL's.

State the progressive dysphagia diet in order from most to least restrictive.

NPO (nothing by mouth) Dysphagia pureed (pudding-like consistency) Dysphagia mechanically-altered (soft, moist food) Dysphagia advanced (regular food except very hard, sticky, or crunchy foods) Regular diet

The most common vitamin supplements include

Multivitamins, vit-C, vit-E, B-complex and calcium.

Keystone to Imogene King's theory

Mutuality achieved through perceptional congruence

Sleep apnea caused by skeletal muscle weakness is a common sleep pattern disturbance noticed in clients with

Myasthenia Gravis.

This National Dysphagia Diet (NDD) is least restrictive

NDD4, regular diet

Is the pyramidal system (cortico-spinal tracts) plastic?

NO

Transdisciplinary model

Newer, in which the client has a primary therapist from the team and then is guided y the team in caring for the client. Ex: Primary therapist is a nurse who provide physical, speech, and OT therapy based on advice and counsel he or she receives from team members in those disciplines. Requires flexibility

T4

Nipple line

Rehabilitation act 0f 1973

Non-discrimination for people w/ disability

Stage Two of Neals Home Health Theory

Nurses in this stage are moderately independant but still need help with office procedures, reimbursement issues and factors that restrict their autonomy

The assessment for helplessness in a disabled client should include

Observance of inactivity, non-participation, self isolation, and withdrawal.

Assessing for independence in a disabled client involves

Observe for initiation of ADLs and participation in academic and vocational activities. Assess the client's level of functional independence (FIM); cognitive abilities; initiation of recreational activities.

What are the legal responsibilities of rehab nurse?

Obtaining voluntary informed consent Maintaining the confidentiality Evaluation of pt competence to make decisions

Pt is difficult to arouse and needs constant stimulus to follow commands; may verbally respond to stimuli with a few words but drifts back to sleep when stimulus is removed

Obtundation

Definition of functional incontinence

Occurs when functional impairments limit the person's ability to use facilities in a timely or effective manner

CN I

Olfactory nerve transmits sensation of smell to olfactory area of the cerebral cortex

How often should skin assessment be done on patients?

On admission, and daily, (every shift if required by the facility

Multidisciplinary model

One in which professional work in parallel, each discipline works toward toward particular client goals with little overlap between disciplines. Communication more vertical than lateral.

Interdisciplinary Model

One is a matrix, lateral communication is predominate, team'goal setting is important.

Medicare Social Security act of 1965

Operates under the department of health and human services and is managed by the centers of Medicare and Medicaid. Eligibility must be a worker or spouse of a worker greater than 65 years of age or disabled >2years. Or ESRD. Eligible for SS are automatically enrolled

The expectation of a favorable outcome.

Optimism

Describe the nursing process behind Orem's theory of self care deficits.

Orem's theory presents a method to determine the self care deficits of a pathient and then defines the nurse or caregiver's role in helping the patient meet his or her self- care demands.

nursing process theory theorist

Orlando

Rehabilitation Services Administration (RSA)

Oversees grant program r/t rehab

PLISSIT sexual counseling acronym stands for

P = permission, LI = discussion and limited information SS = specific suggestions, IT = intenstive therapy if needed

assessment tools for mobility and function

PED-pediatric Evaluation fo Disability Inventory WEEfim Instrument

Nursing roles in community based rehabilitation settings include:

Partner, educator, planner, coordinator, resource manager, evaluator of client outcomes, client advocator

A lack of accidental injuries as a result of medical errors or avoidable adverse events

Patient Safety

classical condition theory

Pavlov-conditioning occurs when a once neutral stimulus becomes analogous with a response after they have been associated with each other -internal response can be changed by modifying behavior -automatic responses evoked by a stimulus

National Institute on Disability Rehabilitation Research define area of interest and funds grants r/t rehabilitation based on .....

Peer review

Self concept, as explianed by the middle range theory states

People change over time, particularly after incurring a disablity. The person's environment changes over

Sigmund Freud's intrapsychic theory states

People experience conflict between their natural instincts and society's restrictions on them. Conflict experienced in childhood influences one's adult personality. Four phases occur within set timeframes. Fixation (oral, anal, phallic) may result if phases are not achieved successfully.

S2-4

Perianal area

This type of pain is initiated or caused by a primary lesion or dysfunction in the peripheral nervous system.

Peripheral neuropathic pain.

According to the PLISSIT model of sexual counseling the "P" stands for

Permission, giving the client permission to openly talk about the subject allowing questions and fears to be raised.

The PLISSIT model for sexual counseling includes

Permission, limited information, specific, suggestions, and intensive therapy.

Person Body and Disease in Halls theory

Person is core, body is care, and disease is cure

Rehabilitation nursing is viewed as a specialty practice guided by what three things?

Philosophy, theory, and research.

Medical Model

Physician centered all directed by physician.

Part B medicare

Physician services financed by Federal taxes and monthly premiums . You must Enroll.

What five areas of assessment should the nurse consider when assessing a client for stress?

Physiological symptoms, emotional, intellectual, spiritual and social manifiestations

Development proceeds from prelogical thought to logical, concrete thought during this stage of development as described in

Piaget's Concrete Operational stage of development

During this stage of development Children begin to fantasize and use symbols to represent objects and feelings. By maintaining stable and consistent images children are able to create a representational world.

Piaget's Preoperational Stage of Development.

Development proceeds from reflex activity to representation and sensory motor learning in this theory of development.

Piaget's Sensorimotor Stage of Development.

Sucking and touching are innate actions for infants, but understanding how personal behavior affects the world and becoming involved in trial and error actions is a process of development described in

Piaget's Sensorimotor Stage of Development.

cognitive theories

Piaget's stages of development Vyotsky's Theoretical framework

Effects of aging (lungs)

Pna, influenza

What nursing intervention can help with snoring or sleep apnea?

Position the patient to a side-lying position and use pillows to retain that position.

When establishing a bladder program what are the main factors to assess?

Premorbid level of function, past voiding habits and use of assistive devices, fluid intake, age, activity, prior bladder problems, mobility impairments, sensory and motor status, neuromuscular status, impaired communication, and medications.

Development proceeds from sensorimotor represntation to prelogical thought during this stage of development according to Piaget's theory.

Preoperative stage of development.

The primary role of the nurse in regards to spirituality is

Presencing or just being there for support or through touch.

What three stages of prevention are in Neuman's model?

Primary, secondary prevention, and tertiary prevention; helps clients maximize their defenses.

Primary, secondary and Tertiary prevention

Primary-Interventions that promote optimal health and provides special protection to prevent illness, disabilities, or injuries (Eating healthy, exercising) Secondary- Interventions that limit disabilities and are done primarily by early identification (Symptoms of high blood sugar or hypertension Tertiary prevention- interventions that decrease disability and impairments caused by illness or injury (Taking aspirin to prevent another MI)

The Health promotion model promotes self efficacy with these core self management concepts

Problem solving, Decision making, Resource use, Collaboration and action.

The Civil Rights Act of 1964

Prohibits employment discrimination based on race, color, religion, sex or national origin.

Name the 2 issues in Title I of the Americans with Disabilities Act

Prohibits workplace discrimination and forbids discrimination in providing public benefits and services

Cushioning bony prominences, providing adequate support, avoiding pressure on existing ulcers, protecting skin from friction and shearing, and elevating the heels off the bed are all nursing measures to

Promote and maintain skin integrity.

Nursing interventions for functional incontinence include:

Prompted voiding or timed voiding schedules, ensuring adequate fluid intake, referrals to PT & OT. Modify environment to be conducive to maintaining independence.

What is the minimal time frame that a skin assessment should be performed?

Proper skin assessment is required on admission and on a daily basis

The minimum data assessment (MDS) is mandated by the CMS for use in long term, subacute, or postacute care. It serves as the data collection instrument for this payment system

Prospective Payment system.

Medicaid Social Security act of 1965

Provides federal grants to states for medical assistance programs. reimbursement is usually lower than cost. Determined by states definition of medically needy and is variable state to state

Intensive Therapy as defined in the PLISSIT model of sexual counseling would incude

Providing expert assistance for intensive discussion and intervention. (e.g., Psychotherapy for marriage and relational counseling, medical management of impotence, infertility, child birth, or previous abuse)

This medication is used to improve wakefulness in adults with a diagnosed sleep disorder.

Provigil-modafinil

Primary nursing delivery model

RNs are utilized to care for a smaller group of patients

This is used to interpret the cognitive recovery process after brain injury, it has levels from 1-10 with lower scores indicating more severe impairment of consciousness.

Ranchos Los Amigos level of Cognitive functioning.

REM

Rapid Eye Movement lack of muscle movement and vivid dreams

Bibliotherapy

Reading

Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of death in the USA, what are the goals of pulmonary rehabilitation for these clients?

Reduce or minimize triggers and symptoms, restore functional ability, and improve the quality of life.

Test ability to protect airway

Reflex cough test

National Dysphagia Diet(NDD3), Dysphagia advanced allows clients to eat

Regular foods except very hard, sticky, or crunchy foods.

Explain the theoretical structure of rehabilitation nursing.

Rehabilitation nurses help individuals affected by chronic illness or physical disability to - achieve their greatest potential, - adapt to their disabilities, and - work toward leading productive, independent lives. Rehabilitation nurses take a holistic approach to meeting clients - medical, - vocational, - educational, - environmental, and - spiritual needs

Explain the theoretical structure of rehabilitation nursing

Rehabilitation nurses help individuals affected by chronic illness or physical disability to achieve their greatest potential, adapt to their disabilities, and work toward leading productive independent lives. Rehabilitation nurses take a holistic approach to meeting client's medical, vocational, educational, educational, environmental, and spiritual needs.

Nursing interventions for post traumatic stress disorder (PTSD) include

Reinforce prior successful coping methods. provide crisis management. Encourage the client to appraise stressors, responses to stress, and approaches to problem solving. Set limits on activities that lead to stress and use guided imagery, spiritual counseling or prayer to decrease stress.

Using various strategies to invoke previous pleasant memories

Reminiscence therapy

Capacity for speedy recovery

Resilience

Parkinson's Disease

Rigidity , tremor ,and slow movement = bradykinesia

C8

Ring and little finger

Transdisciplinary Model

Rn controls providers for client for home health

Humanist

Rogers

Which spinal cord level must be intact for sexual response in either male or female?

S2 to S4

One of the best spiritual assessment tools is

SIBS - Spiritual Involvement and Beliefs Scale which has patient evaluate 34 statements from strongly disagree to strongly agree

interactional model

Schaie -focused on development from young adulthood to older ages -concept of goodness of fit(consonance)vs dissonance(poorness of fit) -adult outcomes may be influenced by childhood events and adolescent experiences

Martha Rogers

Science of Unitary Human Beings theory that focuses on people and their worlds in a pandimensional universe.

Bandura's Theory

Self -Efficacy ,cognitive Theory

Dorothea Orem

Self Care AGency, Self Care Demands make up the Self Care Theory

Orem theory

Self Care Model

According to Maslow's Heirachy of needs an individual who represents morality, creativity, spontaneity, ability to problem solve, lack of prejudice, and acceptance of facts is

Self actualized.

Dorothea Orem

Self care is essential for health, well being and life itself. Theory focuses on individlas self care needs or demands and the ability of the person to meet those needs. Three groups of self-care Universal, development, and health-care. A wholeness of body and mind Nurse helps meet therapeutic self-care demands

Client-centered care

Serves specialized populations such as specific developmental stage (Peds, elderly) or type of impairment (SCI, head injury). Providers can focus their resources and gain expertise through experience

Dantrolene

Side effect : hepatotaxicity

Which sexual position is best for arthritic hip joints?

Side lying with supportive pillows

environmental consequences of behavior theory

Skinner -learning is influenced by the effect of individuals' behaviors -behavior is shaped with positive or negative re-inforcers

Why are pain medications preferred over sleep medications?

Sleeping medications can interfere with REM sleep and often produce artificial sleep.

Is recovery after a subcortical infarction fast or slow? why?

Slow Because it is mainly white matter, thus the cortex (higher up) needs to reorganize to facilitate the improvement of the subcortical regions

The non-physical aspects of a person that shape his relationships and emotions and includes memories, understanding and will.

Soul (related to spirituality)

Client centered Care

Specialized care such as SCI,TBI, Cerebral palsy

CN XI

Spinal accessory innervates the skeletal muscles of the soft palate, pharynx, and larynx, which contracts reflexively.

Intangible life force of an individual

Spirit

An inner awareness and a relationship with a higher force

Spirituality

Martha Rogers

States that humans and environment are energy fields that are intertwined and irreducible

Margaret Newman

States that the pattern of the whole contains the individual as an open system, the family as an open system and the community as an open system...all systems are interacting with one another

Clients should avoid _____________to promote restful sleep.

Stimulants 4-6 hours before bedtime

Glipizide

Stimulates pancreas to make more insulin

Effective Health Management

Strategies necessary in order to achieve and maintain an optimal quality of life in a population of people who live longer and need long term health promotion interventions to prevent further loss of function and prevent secondary complications related to disability.

SSI means

Supplemental Security income and includes NEEDY blind or disabled persons - amended in 1972

Types of urinary incontinence

Stress / Urge / Mixed / Overflow / Total / Functional

What is the third leading cause of death in Canadians?

Stroke

Name two diagnosis that cause temporary disrupted sleep patterns and initial reversal of day-night cycles.

Stroke and traumatic brain injury

Uninhibited Neurogenic Bladder is common in what disease processes affecting the cortex?

Stroke, Brain Injury, Brain Tumors, Multiple Sclerosis

Uninhibited Neurogenic Bowel is common to what disease processes affecting the cortex?

Stroke, Brain Injury, Brain Tumors, Multiple Sclerosis

Definition of Ethics

Study of moral standards and how they affect conduct

Moral decision making involves...

Studying similar cases Conferring with other people involved Decisions falls within legislative and organizational parameters Evaluating the level of comfort a pt has with making particular decision

Pt arouses to vigorus and continuous stimulation which is typically painful in nature; may moan briefly but does not follow commands; only response may be withdrawal from the painful stimulus

Stupor

interpersonal theories

Sullivan 7 stages 1.infancy 2. Childhood 3.Preadolescence juvenile 4. Preadolesence 5. Early adolescence 6. Late adolescence 7. Adulthood

What type of language is the highest form and involves independent creative intention and application of rules?

Symbolic Language

Imogene King

Systems Framework Theory is the personal, interpersonal and social systems

Imogene King

Systems Theory: 3 interacting systems: Personal (individual), interpersonal and social systems. Major concepts include perception, self, growth, image, development, time and space Adjusting to stressors. Nurse and client share perceptions and mutually identify goals and means to obtain those goals

Autonomous, areflexic, flaccid, or atonal bowel disorders originate from spinal cord injuries at or below this level

T12-S1

Reflexic Bowel disorders are associated with Spinal Cord Injury (SCI) above this level

T12-S1 or damage to the cerebral cortex.

Autonomic Dysreflexia occurs in 48-90% of those with spinal cord injuries at or above this level

T6

What is TPA

TPA (tissue plasminogen activator) breaks up clots and is very effective but it is only used about 5% of the time because people don't get to the hospital within 3 hours

What is the best acute treatment for ischemic stroke?

TPA - tissue plasminogen Activator - dissolves clots by digesting fibrin strands (does NOT work for hemorrhagic stroke)

Levine's Conservation Theory

Teaches patient ways to limit energy expenditure during activities of daily living and assisting them in planning rest breaks

Name the issue in Title IV of of the Americans with Disabilities Act

Technology and telecommunications - mandates telephone companies has special relay services for people with hearing and speech impediments, closed captioning of federally sponsored public announcements

Clients with dysphagia may drink water 30 minutes before or after meals. The rationale is that small amounts of water, when when aspirated do not contribute to aspiration pneumonia, provided that good oral hygiene is practiced prior to drinking each time.

The Frazier water protocol.

This nerve sends motor impulses to the muscles of the pharynx and sensory impulses from taste buds of the posterior one-third of tongue.

The Glossopharyngeal nerve, Cranial nerve IX

What theory believes that an individual's behavior controls his or her outcomes?

The Locus of Control Theory. People who believe they are in control of their health are more likely to change their behavior than those who believe outside forces are in control.

The AHA published a Patient's Bill of Rights in 1973 and revised it in 1992, in 2008 published a simplified phamphlet called

The Patient Care Partnership listing 12 patient entitlements

The Americans with Disabilities Act of 1990 is an expansion of which previous law?

The Rehabilitation Act of 1973

Which agency enforces federal laws related to employment discrimination against a person with a disability?

The U.S. Equal Employment Opportunity Commission

Which agency enforces federal laws related to employment discrimination against a person with a disability?

The U.S. Equal Employment Opportunity Commission.

SDH

The bleeding in a subdural hematoma is under the skull and outside the brain, not in the brain itself. As blood accumulates, however, pressure on the brain increases.

The North American Nursing Diagnosis Association (NANDA) defines ineffective health maintenance as

The inability to identify, manage, and /or seek out help to maintain health.

Define ineffective health maintenance by the North American Nursing Diagnosis Association (NANDA) .

The inability to identify, manage, and/or seek out help to maintain health.

Potential effects of impaired memory or judgement problems related to sexual relationships include

The injured partner may perseverate (repeat a response without stimulus) on a sexual activity or request or pressure partner for frequent sex. Contraceptive use should not rely on the memory of the injured partner.

Confabulation

The invention of detail or life experiences in an attempt to compensate for memory deficits

Dr. Nola Pender is credited with the Health Promotion Model. What is this theory?

The personal belief in one's own capacity to control life events is a tenet of the theory. This theory assumes that people seek to regulate their own behavior and that health professionals play an influential role throughout their client's lifespan.

In the transdisciplinary team model

The primary care provider directs the care from the information received from the team members.

Health Promotion is

The process of enabling people to increase control over and to improve their health. To reach a state of complete physical, mental, and social well being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment.

How does the self-efficacy model impact rehabilitation nursing?

The self-efficacy model influences how much effort a client puts in rehabilitation therapy by helping clients maintain a positive attitude toward rehabilitation and confidence to attain new goals.

SAH

The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pia and arachnoid membranes

Successful Rehabilitation nursing includes:

The transfer of knowledge and accountability for healthcare needs from nurses to clients and their families in a manner that promotes health and wellness for the a disability. Strategies are best conceived when developed in a nursing theory framework that provides education and training to address weaknesses and maximize strengths to meet the needs of clients and families to promote health in the community.

Neal theory of Home Health Nursing

Theory that states "In the practice of community centered care, nurses proceed through a three stage process toward autonomy in the role

Interventions for the client with disinhibition or impulse control function problems related to sexual relationships include

The uninjured partner should give feedback to partner about responses and provide suggestions for better alternatives, enforce privacy and a consistent routine. Do not reinforce inappropriate behaviors, and may need to implement social skills retraining in matters related to sexual behaviors with the opposite sex of their partners.

OSERS, Office of Special Education and Rehabilitative Services

Their mission is to integrate people with disabilities into society

Dorothea Orem

Theorist that state that nurses form a supportive-educational system during rehabilation

Neal

Theorist who believes the ability to adapt is necessary to move through stages

Dorothea Orem

Theorist who states that when self care demands exceed self care agency, nursing may intervene

Margaret Newman

Theorist whose theory focuses on community and family centered rehabiliation nursing

Lab values indicative of dehydration are:

These 3 together: Elevated serum osmolality of >300, elevated serum sodium >145, urine specific gravity >1.030.

Why must rehabilitation clients use effective health management strategies?

They are necessary in order to achieve and maintain an optimal quality of life. People with disabilities are living longer and needing long-term health promotion interventions to prevent further loss of function and prevent secondary conditions.

What is the Oral Phase of swallowing?

This is a voluntary action. The tongue is elevated to te roof of the mouth (palate). Lips close to contain oral contents. Buccal and facial tone are necessary for chewing.

What is the Pharyngeal Phase of swallowing?

This is an involuntary event. The bolus is carried by the swallowing reflex through the pharynx. The soft palate and uvula are elevated to close the nasal pharynx. The hyoid and larynx are elevated so food is less likely to enter the trachea.

What is the Esophageal Phase of swallowing?

This is and involuntary event. The bolus enters the stomach via peristalsis and gravity. The lower esophageal sphincter opens.

Lydia Hall

Three interlocking circles: person, body and disease

C6

Thumb

The ADA's five titles

Title I: oversees legislation in employment Title II: public services Title III: public accommodations and services operated by private entities Title IV: telecommunication Title V: miscellaneous provision

Why do our bodies sleep?

To restore energy and support anabolic processes.

Nursing interventions for clients with stress incontinence include

Toileting assistance, bladder training, and referrals to MD for pharmacological management.

Title II of the American with Disabilities Act prohibits discrimination in

Transportation provided by state and local government

CN V

Trigeminal nerve innervates muscles of mastication and sensory impulses from teeth, gums, and lips.

True or False: Healthcare costs for the disables is at least 4 times the amount for other patients

True

True or False: Many of the factors that impace the coping process are related to the person's sense of self and her abilities.

True

Erik Erikson's first stage of Psychosocial development emphasized

Trust vs mistrust. Viewing the universe as reliable and seeing relationships as stable and available.

diabetes Types

Type1,Type2,gestational, specific genetic defects,Pre-diabetes

Uninhibited Neurogenic Bladder results from:

UMN damage in the brain which fails to suppress reflexive contraction of the detrusor.

Uninhibited neurogenic bowel problems result from?

UMN damage in the brain, limiting recognition of signals from the bowel that it is full.

T10

Umbilicus

Disinhibition

Uncontrolled behaviors considered inappropriate

What are the keys to developing advocacy skills?

Understanding and knowledge - of one's self personally and professionally, - of the treatment and intervention options, - of the healthcare system, and - how to put advocacy in action

Lewins theory of changes

Unfreezing is the need for change. Movement is increased level of behavior. Refreezing is change and set, new status quo. Forces can be either driving a restraining forces

Cause if what problem: UMN damage in the brain which fails to suppress reflexive contraction of the detrusor.

Uninhibited Neurogenic Bladder

Features of what problem: 1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal to hyperactive bulbocavernous reflex 4)sudden voiding with our without urgency, frequency or nocturia 5)decreased bladder capacity

Uninhibited Neurogenic Bladder

Most common neurogenic bladder problem following stroke

Uninhibited Neurogenic Bladder

Strategies for what problem? 1)maintain adequate fluid intake, but avoid exceeding 2000ml/24 hrs 2)decrease fluid intake early in the evening to avoid nocturia 3)use timed voiding, prompted voiding or habit training to increase continence based on the pt's cognitive abilities 4)use bathroom schedules based on the pt's usual time of voiding 5)use anticholinergic meds to decrease detrusor contractility and to increase bladder capacity 6)make sure it is easy for pt to get to the bathroom in a timely manner

Uninhibited Neurogenic Bladder

Common strategies for what type of bowel problem: 1)avoiding constipation 2)insuring an adequate intake of fluids and fiber (bulk) 3)facilitating adequate exercise 4)weaning from bowel medications if possible 5)using bathroom schedule based on the pt's usual time of defecation 6)using suppositories or mini enemas to stimulate emptying at a predictable time, if bathroom scheduling is ineffective 7)making sure it is easy for the pt to get to the bathroom in a timely manner

Uninhibited Neurogenic Bowel

Features of what bowel problem? 1)intact or hypertonic internal and external sphincters 2)intact saddle sensation 3)normal or hyperactive bulbocavernous reflex 4)sudden defecation with or without urgency 5)hard stool with smearing

Uninhibited Neurogenic Bowel

Most common neurogenic bowel problem following stroke is:

Uninhibited Neurogenic Bowel

UMN damage in the brain, limiting recognition of signals from the bowel that it is full...results in what bowel problem?

Uninhibited Neurogenic Bowel

Neurogenic bowel

Uninhibited or reflexive typem sudden involuntary defecation

Persevation

Unintentional repetition of a word or phrase

Martha Rogers

Unitary Human Beings focuses on people and their worlds in pandimensional universe. Human beings are whole, not parts. The human and environment are energy fields that intertwine and are unitary field. Rogers calls this integrality. Change is fundamental to life, its never the same. Health-individually defined; an expression of the life process. Nursing-a learned profession; a science and art of promoting health.

Spastic bladder dysfunction (failure to store urine) is often associated with

Upper motor neuron spinal cord injuries.

What are advocacy skills in Rehabilitation nursing?

Using the Nursing process (assessment, planning, and implementation) to empower a client to choose treatment and intervention options available within a healthcare system.

CN X

Vagus nerve causes contractions of muscles of pharynx and larynx.

This nerve causes contractions of muscles of pharynx and larynx

Vagus nerve, Cranial nerve X

Dorothea Orem

Views health as a state of wholeness or integrity

Behavioral

Watson

In dehydration pt may complain of what?

Weakness, dry mouth

What is wellness?

Wellness is a journey that each of us takes in our quest for well-being of body, mind, and spirit. Key components include - personal responsibility - balance through all phases of health - body-mind-spirit connectedness and, - relationships with self, others, and the environment (Miller, 2008). Wellness is a choice to assume responsibility for the quality of your life. It begins with a conscious decision to shape a healthy lifestyle.

Ability to speak with ease and use proper syntax but use incorrect words, nonsense words and phrases and have loss of visual fields.

Wernicke's aphasia

An example of Receptive aphasia is

Wernicke's aphasia

Which part of neuroanatomy is responsible for sound pattern recognition?

Wernicke's area

Problems during pharyngeal phase of swallowing

Wet or gurgly sounding voice after eating / frequent throat clearing , c/o food sticking to throat

physics

What Martha Rogers theory is based on

Functional Reorganization

When one area of the brain is damaged, another area takes over

When are physical restraints allowed under federal law?

When used to treat a specific medical condition.

Lydia Hall

Who asserted that only wholly professional nursing care would hasten recovery?

Lydia Hall

Who asserted that setting goals for clients that do not reflect the clent's own goals is countertherapeutic?

Lydia Hall

Who assets that nurses should focus teaching and learning on the client?

Lydia Hall

Who defined rehabilitation as the process of learning to live within limitations?

Lydia Hall

Who's view of health asserts that people behave according to feelings rather than knowledge?

Dorothea Orem's view of the person

a biological, symbolic and social unit

hemorrhagic stroke

a blood vessel breaks/bursts, interrupting blood flow

A nursing theory is

a body of knowledge used for nursing practice.

atherosclerosis

a build up of plaque in the inner lining of the artery, causes it to narrow or become blocked

Kurt Lewin's Change theory includes three stages of change. Stage 2 "movement" includes

a change in thoughts, feelings, and behaviors.

The definition of case management as defined by the Case Management Society of America is

a colloborative process of assessment, planning, facilitation, and advocacy for options and services that meet an individual's health needs through communication and available resources to promote quality cost -effective outcomes.

What is an IMPORTANT condition that must be present for a team to be successful?

a commitment to a common purpose and specific goals

According to the World Health Organization (WHO) Handicap is

a disadvantage from an impairment or disability that limits or prevents normal function.

Handicap

a disadvantage resulting from impairment or disability that limits or prevents the person from filling a role that would be normal for them. (societal level)

asia impairment scale

a for absent motor and sensory function b for incomplete sensory but no motor function below injury c incomplete some motor function below injury but is NON-functional D incomplete Functional motor funcion belwo the level of injury E Normal Sensory and motor function are Normal

The Code of Ethics for Nurses as established by the ANA provides

a framework for nurses to use in ethical analsyis and decision making composed of nine provisions that establishes a standard for the profession.

Community re-entry and integration allows the transition to community through

a gradual acquisition of community skills, self care, leisure and vocational activities, and psychosocial integration.

A client experiencing powerlessness may exhibit

a lack of initiative in goal planning and achievment; passivity; withdrawal from family, social, and vocational decisions and interactions.

What are the characteristics of rapid eye movement (REM) sleep?

a lack of muscle movement, and vivid dreaming.

Impairment

a loss or abnormality of a psychological, physiological, or anatomical structure and function (Organ level)

The integral nursing theory provides

a multifaceted approach t the metaparadigm of a person described within four domains.

An ethical dilemma is when

a person is forced to choose between two equally difficult actions because they are both right, or uncertain.

According to the World Health Organization (WHO) Disability is

a restriction or lack of ability to perform an activity in a normal manner.

The Wong-Baker FACES scale is

a scale with drawings or pictures that clinicians use to assess pain in the cognitively impaired client.

The Assessment instrument for Problem focused Coping (APC) is

a self report instrument that focuses on a person's own assessment of competence in coping with activities of daily living (ADLs), personal problems, and level of satisfaction with ADLs.

Self efficacy is

a sense of control that consists of coping with, appraising, and managing one's life.

Diane Kempson suggests this type of treatment for complex post traumatic stress disorder (PTSD)

a specific focus on body-oriented therapies to facilitate the return to normal neurobiological functioning, thereby enhancing efficacy of talk therapies in the resolution of complex PTSD.

What causes a brain attack?

a stroke or a TIA

What is Narcolepsy?

a syndrome characterized by sudden sleep attacks, sleep paralysis, and visual or auditory hallucinations at the onset of sleep.

Cognitive strategic control

ability to sustain attention over a period of time

Hemoglobin

ability to transport O2

Hemoglobin indicates

ability to transport oxygen.

The Americans with Disabilities Act (ADA) mandates

accessible public transportation and bans potential employers from asking questions about disability.

What are ADLs?

activities required to maintain a daily life existence. This is primarily eating, dressing, and bathing or grooming.

anterior cord syndrome

acute flexion to cervical area, damage to anterior spinal artery affecting anterior 2/3 of cord,produces paralysis, loss of pain and temperature sensation below the injury, preservation of position sense

pain classification

acute, chronic

The ethics committee is an interdisciplinary group of healthcare professionals who

address ethical dilemmas that occur in a particular setting.

Day Treament care programs

adult day services, health , social support, promotes sense of control and self determaination,

The last 4 provisions of ANA Code of Ethics address

advancement of the nursing profession and its values, specifically the use of individual collective actions, general contribution to nursing improvement, participation in community and national efforts and collective assertion of nursing values

C3 - C5 spinal injury

affect diaphragm

Psychosocial characteristics of nurturing families include

affection, genuineness, honesty, open communication and love.

AMyotrophic Lateral Sclerosis

affects both upper and lower motor neurons

Cauda Equina Spinal Injury

affects lower motor neurons bowel, bladder and sexual function

post polio syndrome

affects survivors 10-40 yrs after acute attack, s/s-fatigue, pain in muscles and joints, sleep, breathing and swallowing difficulties, may experience muscle atrophy or wasting

emphysema

air gets caught in thhe lungs because they lose elasticity making it difficult to exhale caused by smoking,recurrent infections, alpha 1-antitripsin

The Functional Measurement tool (FIM) documents the 1st 3 days and last 3 days of hospitalization by

all disciplines involved in patient care.

In the holistic nursing concept the environment is

all physical surroundings, people and things that are present.

How does an independent living program support an individual with a disability?

allows pts. to remain in their own dwellings while offering support services

Compression Spinal Fracture

also know as wegde

Hope is

an anticipation of a future that is good and is based on relationships with others, purpose, meaning in life, and a sense of the possible.

Apathy

an attitude characterized by bland affect lethargy and decreased motivation

Low self esteem and low self worth manifest as

an expectant deprecation, often accompanied by a "victim mentality"

In the holistic nursing concept illness is

an imbalance in the human energy field.

Why is leg motor and sensory function often preserved after stroke?

anastomoses between ACA and MCA

hematological problems of the elderly

anemia- d/t less eating less meat/protein, and blood loss further reduces reserve capacity.

Autonomy

anothers right to self determine a course of action

When educating a client on sexuality and reproduction the rehab nurse should

answer all questions, promote an atmosphere of permission and acceptance, and separate your own values and attitudes regarding sexuality to address the issue objectively.

The following drug classifications can contribute to sexual dysfunction

antidepressants, antihypertensives, anticholinergics, anticonvulsants, histamine 2 blocking agents, lipid lowering agents, digoxin and opiods.

What types of drugs would be MOST likely to cause male ejaculation and impotence problems?

antihypertensives, antispasmodics, calcium channel blockers, tranquilizers, anticonvulsants, alcohol, and analgesics

Emotional signs of stress include

anxiety, emotional lability, restlessness, or fright.

Megace (megestrol) or Oxandrin (Oxandrolone) is prescribed for client's whos oral intake is less than 25%. What type of medication are these meds?

appetite stimulants.

types of exercise for ms

aquatic,yoga, tai chi

Autonomy is the ethical principle that individual actions

are independent of the actions and will of others.

Latent error

are those that have consequences observable only over time, such as admin policies, inadequate staff, poor equipment

risk factors for ischemic stroke

arterial hypertension, smoking, dm, insulin resistance, thrombocythemia and polycythemia, impaired cardiac function, hyperhomocysteinemia, post-menopausal women, advanced age, oral contraceptives, age, previous stroke

Discharge planning should begin

as soon as the patient is admitted

When assessing client mobility the nurse should

assess ROM (range of motion), balance, bed mobility, transfer ability, wheelchair ability, ambulation, neuromuscular problems, coordination and proprioception, cognition, patient expectations, growth and development, and comorbidities.

When faced with an ethical dilemma what must the rehab nurse do FIRST?

assess her own personal values

management of chf

assessment of heart and lung, treat the cause,decrease the workload-pace activity,energy conservation,rest periods am and pm, fluid restriction,salt restriction,daily weights,accurate intake and output,monitor of pulse and bp

Specific Suggestions as it relates to the PLISSIT model of sexual counseling would include

assisting people with problem identification, providing specific suggestions to resolve a problem.

Rehabilitation nursing goals

assisting the individual with a disability or chronic disease toward maximal health through health restoration

Poikil - Thermia

assuming the temperture of the enviornment

Myasthenia Gravis

auto immune disease, presence of abnormal thymus glandmuscle fatigue,drooping eyelid, speech/swallowing difficulties,extremity weakness, resp weakness,

Above T6 Spinal Injury

autonomic dysrelexia / orthostatic hypotention

Which of the following is a barrier to independent living for the C4 spinal cord injured patient?

availability of affordable, accessible housing

Serum Albumin

available protein stores

Revenue is related to the following

average daily census, Functional independence measure (FIM) of typical patients which determines the case mix group (CMG), Length of stay, number of discharges

nonmaleficence

avoidance of harm or hurt

Section 188 of the Workforce Investment Act

bans discriminination against disabled persons in federally funded employment service centers

What is the most common site of hemorragic stroke?

basal ganglia

diagnosis of GBS

based on clinical presentaion, recent viral infection, lumbar puncture shows csf proteins increase, emg-decrease nerve conduction

Why is a stroke in the corona radiata so significant?

because so many tracts are in this area - particularly more caudal in the corona radiata

nusing process theory

behavior of individual the nurses reaction, and subsequent nurses

Personal competence with coping in regards to relationships involves

being content with self and others.

Margaret Newman

believes that changes in the health status of an individual or family result in changes in the pattern as related to the whole community

Imogene King

believes that goal setting is not a one time event but rather an ongoing process

When comparing one facility's selected outcomes with those of another facility's outstanding outcomes this is considered which process?

benchmarking

Participants in health care have combined widely shared human beliefs about health and illness into four major ethical principles. What obligation requires health care providers to help people in need?

beneficence

diagnosis of muscular dystrophy

biopsy,emg,blood enzymes

Educational topics for clients with urge incontinence include:

bladder training/retraining, Urge inhibition if the client is cognitively intact, pelvic floor muscle exercises (Kegels)

Pathology of MS

blood brain barrier is breached as activated T-cells migrate into cns, triggering antibody-antigen reaction resulting in inflammation, loss of myelin, loss of oligodendrocytes and proliferation of astrocytes that remove damaged myelin, forms scar tissure over affected area

ischemic stroke

blood clot blocks a blood vessel or artery

hemoglobin A1c indicates

blood glucose during the last 3 months.

myeloma

bone marrow cancer

sarcoma

bone, cartilage canncer

Diabetes Insipidus

brain fails to produce ADH = voids often , dehydration

Uninhibited Neurogenic Bowel

brain is not able tell when bowel is full.

What is the worst area of the CNS to experience a hemmoragic stroke?

brainstem

Which techique allows the user to determine the volume of pts. required for a progam to be financially self-sufficient?

break-even analysis

treatment of uninhibited neurogenic

bulk fiber and fluids, avoid gas producing foods, check medications, bowel and bladder programs

treatment of areflexic

bulk fiber, maintain intake to 2000ml/day, some pts get ostomy to resolve problem

dysphagia in esophegeal phase

burping, indigestion,substernal pain from esophgeal reflux, c/o of bad taste in mouth,bad breath,coughing, wheezing, high indidence of dental cavities

leukemia

cancer that affects the blood forming elements of bone marrow

One lump sum payment made to the provider for each patient's treatment during a month or year is referred to as:

capitation payment

treatment for chd

cardiac catherization,ptca,athrectomy,ablation,cabg,pacemaker,aid

Dysphagia clients may use these techniques to prevent aspiration.

chin tuck, head turn, tongue sweep, double swallow & small sips of water between bites via spoon or cup.

neuropathic

central,peripheral

Cogenital Condition of children

cerebral palsy,spinal bifida,muscular dystrophy,cystic fibrosis

cancer warning signs

changes in size,color,shape, or thickness of a wart, mole,oral sore, repeated infections,persisten cough or hoarseness, lumps or thickened area anywhere on the body, changes in bowel/bladder habits

Mutiple Sclerosis

characterized by inflammation,demyelization and plaues in the white matter of the CNS & scarring of the myelin sheath in the CNS. Affects areas in the brain, optic nerve and spinal cord

To assess for cognitive ability and function...

check mental status for confusion, disorientation, and executive functioning.

To assess for impairments in self care ability,

check motor function, sensory perception, cognitive ability, and level of pain.

To assess for sensory impairments....

check the visual field and acuity, tactile loss or deficit, and hearing.

Anxiolytics, sedatives, and antipsychotics can be considered what type of restraint?

chemical.

s/s of cm

chest pain,exertional dyspnea, s/s of chf and pulmonary edema

Oral Phase

chewing / making a bolus / moving bolus to back of mouth

Behavioral theories

classical conditioning theory-pavlov environmental consequences of behavior theory-skinner Interactional Model-Schaie

Nurse wellness coaching involves the use of

coaching and mentoring competencies in order to improve patient care and the patient experience.

What ilicit drugs cause hemoragic strokes?

cocaine

Coping is defined as

cognitive and behavioral efforts directed at managing demanding and stressful situations

Psychosocial characteristics of troubled families include

coldness, rigidity, control, secrecy, guarded communication and tolerance rather than love

injury to brain stem at reticular formation

coma

Case Management

common provider-centered model within rehab,goal is provide high-quality, individualized,cost-effective care through the process of assessing, planning, organizing ,coordinating, implementing,monintoring,and evaulating their services and resources needed for an individual

Workers compensation is a government sponsored and employee financed system for

compensating employees who incur an injury or illness in connection with their employment.

Some suggestions for the client with bowel dysfunction problems related to sexual relationships include

complete the bowel regimen before sexual activity; avoid positions that place pressure on the bowels; cover ostomy.

Section 504 of the Rehabilitation Act of 1973 addresses

compliance with federal standards for physical disability in facilities Bans housing discrimination in public accommodations or private housing Prohibits unfairness in federally funded school Proscribes descrimination in privately operated transportation services

Martha Rogers

considers nursing to be an abstract body of knowledge

cerebrum

consists of two hemispheres, left side logic and logic, right side abstract, front motor, back sensory

The Joint Commission (JC) is an accrediting body of most healthcare institutions that's mission is to

continuously improve health care for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care.

Injury C3 , C4, C5

control diaphram, At C5 will be able to breath independently but cannot cough due to lost of diaphram control

temporal lobe

controls hearing taste, smell,Wernicke area,sequencing,memory

Integrative medicine is the combination of

conventional biomedicines used in conjunction with complimentary approaches.

Interventions for post traumatic stress disorder (PTSD) include

counseling, anxiety reduction, emotional support, support system enhancement, coping enhancement, active listening, presence, grief work facilitation and referral.

Interventions to assist a client with effectively managing post traumatic stress disorder (PTSD) include

counseling, anxiety reduction, emotional support, support system enhancement, coping enhancement, active listening, presence, grief work facilitation, and referral .

75% to 60% Rule

created in 1984,TEN catergories for admission for rehab, 2003-increased to THIRTEEN

diagnostic test for stroke

ct scan, mri, blood tests, angiogram,ekg, chest x-ray,ecg,lp,carotid studies

cerebrospinal fluid

cushions,protects,circulates within subarachnoid space,carries nutrients to and from the cns

source of pain

cutaneous,somatic,visceral

cauda equina syndrome

damage below conus to lumbar-sacral nerve toos, areflexxic bowel,bladder, areflexic lower extrem

conus medullaris syndrome

damage to conus and lumbar nerve roots, areflexic(flaccid) bowel,bladder, sexual function and lower limbs, areflexic lower extremities

brown-sequard syndeom

damage to on one side of cord, ipsilateral paralysis and loss of touch, pressure,vibration and proprioception on same side of injury Contralateral-loss of sensitivity of pain and temp on opposite side associated with penetrating injuries

Parkinson's Disease

damage/destruction of dopamine producting neurons in the substantia nigra w/in basal ganglia which causes trmor,rigidit,bradykinesia, postural instability

Suggested interventions for clients with attention or concentration problems related to sexual relationships include

decrease external distraction during sexual play; use of relaxation, imagery, or guided fantasy by uninjured partner.

injury to cerebellum

deficits on the same side of body as injury, hypotonia movement,postural changes and wide-based gait,ataxia

Imogene King

defines health as a dynamic life cycle

dysphagis in pharyngeal phase

delayed or absent swallowing, coughing, hx of aspiration pneumonia, weight loss, fear of eating/drinking, wet sounding voice while eating or drinking, freq clearing of throat, c/o something sticking or burning the back of the throat

coronary arteries

deliver blood to the heart muscle

Martha Rogers

describes nursing as a learned profession with the goal of promoting health and well being

Most sexual problems are classified as problems of

desire, excitement, or orgasm phase disorders. Combinations of the three may exist.

Self efficacy leads to the conviction that the person can

determine behaviors that lead to desired outcomes

The Functional Measurement tool (FIM) documents and evaluates performance improvement to

develop and maintain a plan of care.

goals and interventions for PD

develop coping stragies, improve knowledge, maintain indep in ADL, maintain safety

Marjory Gordon

developed a data collection system comprised of 10 functional health patterns necessary for assessment of a patients life experiences

Betty Neuman

developed a health care systems model in which the person is viewed as an open system in interaction with the environment

Variables that influence coping efforts include

developmental age, severity of disability, visibility of disability,

Plissit Model

dialogue about sexuality, Permission giving, Limited Information, Specific Suggestion, Intensive, Therapy

Examples of methods to assist in coping enhancement include

didactic exercises, feedback, counseling, boundary setting, detail planning, recognition of coping sabotage

A healthy heart lifestyle includes

diet, exercise and stress management.

Intellectual signs of stress include

difficulty in concentration and memory

visceral

diffuse pain,slow c-fibers

Title I of the American Disabilities Act was enacted in 1992 to prohibit

discrimination in the workplace against people with disabilities.

cardiomyopathy

disease of the heart muscle 1. dilated cm 2.hypertrophic cardiomyopathy 3.restrictive cm

insulin resistance

disorder in which cells do not use insulin properly,causes the pancreas to produce larger amounts of insulin in an attmpt to normalize blood glucose levels, fat cells are broken down and release free fatty acids, leads to metabolic syndrome and type 2 diabetes

Anterior cord syndrome

disruption of blood supply to anterior 2/3 of spinal cord

How does a TPA help?

dissolves clots which salvages penumbral tissue

Personal competence with coping in regards to differentiation involves

distinguishing between self and others

meperidine

do not use for persistent pain because of buildup of toxic metabolic,causes seizures and dysphoria,not reversible with naloxone

What is beneficience?

doing good

What is non maleficence?

doing no harm

beneficence

done for the benefit of others

Sister Calista Roy

drew her theory from the adaptation theory

dysphagia in oral phase

drooling on weak side, asymmetry of face, pocketing of food, altered lip closure and inability to close lips, wak or absent gag reflex, extended periods of time required to finish eating, chewing problems

injury to basal ganglia

dyskinesias,muscle tone alteration,rigidity, bradykinesia,tremors,athetosis,chorea

Interventions for ineffective health maintenance include:

educate the client at their learning level, determine readiness to learn, use memory aids, help the client identify and begin to resume family role responsibilities, identify adaptation strategies, and assist client and family to develop stress management skills.

Cognitive support as part of social support includes

education, advice, information, role modeling and counseling.

cancer interventions for acute stage

education,diagnosis prognosis,treatment with side effects,nutritional needs, risk of infection, pain relief,

Roles of a rehabilitation staff nurse include

educator, advocate, caregiver, and collaborator.

Characteristics of communication skills include

effective listening, self awareness, and conflict resolution

Emotion Focused coping involves

efforts directed at decreasing negative emotions.

Problem focused coping involves

efforts directed at lowering or eliminating threats.

Medicare is the federal health program for

elderly or disabled under the U.S. Department of Health and Human Services (DHHS).

The most successful leaders are

emotionally intelligent which means they are driven by qualities such as empathy, self - awareness, self-control, the desire to achieve, and social adeptness.

frontal lobe

emotions, personality,problem solving,judgement, voluntary motor movements, broca's area

The patterns of knowing as expressed in the practice of integral nursing are

empirical knowledge, personal knowledge, ethical knowledge, aesthetic knowledge, sociopolitical knowledge and not knowing.

Interventions to promote family integrity include

encourage family therapy, provide training in communication skills, provide the means for lifetime planning for continued care, and help the client and family identify and cope with changes in roles and responsibilities.

Nursing interventions for the client feeling powerless include

encourage the client and family to make decisions, promote environmental predictability and emotional support. Enable the client and family to recognize and mobilize their strengths and resources & utilize effective coping skills.

The rehabilitation Act of 1973

encouraged efforts to hire people with disabilities and prohibited unfair treatment of individuals with disabilities in activities supported in any way by federal funds.

therapeutic touch, healing touch, and comfort touch are all forms of

energetic healing through touch.

To reduce the risk of falls

ensure a safe environment free from barriers and hazards, and institute protective devices.

The rehabilitation nurse promotes good nutrition by:

ensuring the client understands the importance of diet, and encouraging dietary compliance. Assisting those who need help with the eating process. Taking and recording client weight and calorie count. Advocating and communicating between disciplines of physician, dietician, and other health care team members with patient and family preferences.

justice

equal and fair distribution of resources

The American with Disabilities Act (ADA) allows people with disabilities

equal opportunities, accessibility, and accommodations in imployment, transportation, and public access.

Instrumental support as part of social support includes

equipment and services

Capital requirements include

equipment, furniture, construction

The normal gait involves six components, name them

erect balance, a foot lift, a push off with the alternate foot, a heel strike, a ride over, and a heel strike of the opposite foot. Contralateral arms may swing to provide stability and balance.

What are the 4 categories of ethical theories

ethics of divine commands selfishness duty and respect consequences

The SLP (speech language pathologist) is a specialist in

evaluating and treating communication and swallowing problems.

chronic bronchitis

excessive mucus obstructs airway causing chronic cough and scarring of bronchial tissue

Active error

executed by nurse or other health care provider whose consequences are immediately observable.

Spasticity management may be achieved through...

exercise, stretching, oral medications like valium, baclofen, klonopin, and benzodiazepines. It may also be managed through direct botox injections at the site or implantation of a baclofen pump to provide intrathecal medication.

What areas does the Glascow Coma Scale test?

eye response, motor response, and verbal response

Flaccid Bladder

failure to empty, associated with lower motor neuron spinal cord injury

Spastic Bladder / Neurogenic bladder

failure to store urine, associated with upper motor neuron spinal cord injuries

Characteristics of "Grief associated with disability" may include

fatigue, apathy, appetite loss, low self esteem, sadness, guilt

Personal competence with coping in regards to self esteem involves

feeling worthy about ones self

Which ethical principle is exemplified by the rehab nurse who spends numerous hours in the preparation of a teaching plan for the pt, and future family caregivers?

fidelity

Sympathetic nervous system

fight or flight / slows peristalsis /

treatment for autonomic dysreflexia

find cause/stimulus, monitor bp and pulse, sit pt up, raise head of bed to encourage orthostatic, adminster appropriate medication, look for cause and remove stimuli such as empty bladder, empty bowel, check skin to prevent pressure ulcers

The basis of nursing staff development is

further education

management of ALS

focus on pallative care and comfort,key managment decisions discussed in advance of crisis, education on symptom management

Complimentary and alternative medicine (CAM) may include

folk medicine, herbal medicine, homeopathy, faith healing, massage therapy, energy healing, acupuncture

The Rehabilitation Act of 1973 included guidelines

for dondiscrimination in employment, and promoted community access by reducing or eliminating physical barriers.

When the Rehab nurse checks for spasticity, flaccidity, paralysis, contractures, tremors, rigidity, energy, endurance, strength, safety, and balance they assessing....

for motor impairments.

Acute Care units for Elders (ACE units)

for older adults, homelike physical environment, client and family centered, units located in acute care hospitals, goal is to transfer to a rehab unit

One crucial component toward healing is

forgiveness (pardoning oneself and others)

Nursing interventions to prevent a client from feeling helpless include

foster voluntary responses and independence. Encourage learning and reinforce successes. encourage the client to take personal inventory and affirm his/her feelings and expressions of hope.

How do we assess functional upper limb recovery in stroke?

fractionated movement of the fingers (it shows that the corticospinal tract is still in tact)

xenografts

from another species / pig

Allografs

from the same species / cadaver

Expressive aphasia

frontal lobe damage / comprehension intact

Awake, alert, atentive, can follow commands

full consciousness

The major focus of King's nursing theory is:

goal attainment through interaction

Community Base Rehab (CBR)

goal to enhance the quality of life for people with disability, meeting basic needs, ensuring inclusion, and participation. health, education, livelihood, social, and employment

lateral descending motor nerve tract

goes own the spine to the reflex arc s2-4 and triggers the bulbocaverbisis reflex to open the external spincter muscle and allow the urine to leave the bladder

Virture ethics places emphasis on developing

good character that leads to proper decisions

obesity

grade 1-bmi 25-29.9 over weight grade 2-bmi 30-39 obese grade 3 bmi 40 morbidly obese

Interpersonal psychotherapy focuses on

grief, interpersonal role disputes and role transitions.

What is the biggest risk for stroke?

having had a previous stroke or TIA

Which strategy, when implemented prior to discharge, promotes communication, defines the roles of each party, clearly outlines expected outcomes, defines the limitations of care, and establishes home health care agency liability?

health contract

Autograf

healthy skin graft of unburned area

The philosophy of rehab nursing is

helping a person to reach the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with the client's potential.

non-modified risk factor for chd

heredity,race,gender,age

Some medications that represent an increased risk for loss of skin integrity are

high dose steroids & immunosuppressants

Patients with which diagnoses would be likely to have restrictive lung disease?

high level spinal cord injury

nutrition for ms

high protein, low fat, low cholestrol

The National Database for Nursing Quality Indicators include

hospital acquired pressure ulcers, safely administered medications, prevention of hospital acquired infections, rate of falls

Per diem payments

hospital is pain one amount for all services delivered during one day

Per discharge payments

hospital is pain one amount for all services delivered during one stay

total person systems theory

how individuals react to stress through defense and resistance

The collective interior domain of the integral nursing theory is known as the "We" space. It involves

how we can come together to share our cultural background, stories, values meanings, vision, language, relationships and how to form partnerships to achieve the healing mission.

rogers science of unitary Human being theory

human beings and environment are energy fields. Energy fields, openness, pattern, pan dimensionality

Energetic touch is based on the interaction of the

human energy fields between teh provider and the client.

rapid acting insulin

humaolg,novlog,apidra

action

i'm doing it, but it takes work

Jacqueline Fawcett

identified four central concepts that provide the foundation for nursing theories: person, environment, health and nursing

The admission liaison nurse

identifies clients who meet program criteria and will benefit from program services through screening, education, and recommendations.

general theory of nursing

identify needs, plan delivery of care manage care

What would be the BEST approach for the rehab nurse with a new interest in political activism?

identify one issue of interest and act on it

goal and intervention for MG

identify s/s of disease distingusidh type of crisis, uses energy conservation, resp support, main nutrition choices require less work to chew, manage medication s/e, manage energy output throughout the day

Ataxi

impaired ability to coordinate movement / intentional tremeors / jerky movments

interventions and goals for pps

implement energy conservation, maintain funcion in affected limbs and limit atrophy, maintain breathing patterns& oxygenation, maintain nutritional support, prevent dvt, maintain B&B elimination, provide psycologial and emotiona support

R side brain stroke

impusive / denial of deficits /

Broca's aphasia is marked by the

inability to form or difficulty forming words, difficulty writing, and impaired ability to read letters numbers or written material.

chf

inability to increase cardiac output to meet body's metabolic need, decreased myocardial contractility,increased myocardial workload,cogential heart disease

Bradykinesia

inability to initiate movement or change momevment / Rigidity , tremor, and slow movements / symptoms of Parkinson's disease

Asterognosis

inability to sense objects by touch

The serum albumin

indicates available protein stores.

Hemoglobin A1c

indicates average blood glucose during the past 3 months

The four domains of the integral nursing theory are

individual interior, individual exterior, collective interior, and collective exterior.

maslow's hierachy of individuals

individuals needs 1. self-actualization 2. esteem 3.belonginess 4.safety 5.physiologial needs

What 2 coping styles indicate nursing interventions are needed?

ineffective and defensive

use of pain scale for child

infant and young children use FLAAC 3-7 use face scale 8 and older use number scale

Name the tenets of the Nuremburg code

informed voluntary consent expectation of benefit design principles based on animal studies Prior knowledge regarding the problem evaluated no expected harmful outcomes greater probability potential good rather than endangerment Prevention of patient suffering Protection of patient

Positive self esteem is fostered by

integrity, honesty, responsibility, compassion, and competence.

Who is responsible for developing, implementing, documenting and evaluating the treatment plan?

interdisciplinary team

treatment for MS

interfeeron beta products, glatiramer acetate(CoPaxone),Monoclonal antibody(Tysabri)

vascular supply to brain

internal cartoid left and right provides 80% blood to brain, vertebral arteris right and left supply 20% to brain

Nursing interventions for defensive coping should include:

interventions related to self-awareness, fostering relationships.

developmental theories

intrapyschic theories-Freus intrapersonal theories-sullivan social learning-Erickson

Which statement is incorporated in Orem's self care theory?

investigation/decision making where the pt. has control and input regarding activity

myasthenia crisis

involes resp and accessory muscles escalates requiring mech ventilation CAUSE: infection,fever, adverse reaction to med and insufficient med

limbic system

involved in emotions,motivation, memory,deep inside the brain,primitive emotions,fight or flight response,runs on serotonin

The team nursing approach for patient care delivery

involves an RN being responsible for a large group of patients and other personnel

Holistic Approach

involving mind, body and spirit

obstructive asthma

irritants inflame the lining of the trachea and bronchial tubes causing vasoconstriction of the smooth muscles of the airway passages,increased mucus secretion int eh airway, pt is unable to recive oxygen into the blood and carbon monoxide is trapped inside

Medical model

is the traditiponal way of providing healthcare services. Not consistent with rehab philosophy or goals and uncommon in rehab practice

Overall goal of rehabilitation

is to improve quality of life and to help a person "reach the fullest physiological, social, vocational, avocational, and educational potential consistent with his or her physiologic or anatomic impairment, environmental limitation, and desires and life plans." (Delia, Currie, & Martin, 1988)

Functional outcome measurement data collection

is used to communicate client progress, defines the quality of the rehab progress, and

what has a worse prognosis, hemoragic or ischemic stroke?

ischemic (hemorrhagic patients tend to be younger and healthier)

major types of strokes

ischemic and hemorrhagic

maintenance

it's almost routine

middle cerebral artery occlusion

known as MCA, most common stroke, largest branch in internal carotid artery, supplies lobes-frontal,temporal,parietal for primary motor and sensory areas for face,throat, hand, arm,aphasia,dyphagia, dyslexia,visual field deficits

restrictive lung disease

known as interstitital lung disease -damage lung tissue causes walls of the air sacs to become inflammed-leads to scarring-causes lungs to become stiff-making difficult to GET AIR INTO the lungs

type of ischemic stroke

lacunar infarct is clot in small cerebral arteries deep, results in a stroke pure motor, pure sensory, or ataxic hemiparetoc deficits

A person with Amyotrophic Lateral Sclerosis (ALS) may need augmentative communication devices. These include

language boards, paper and pen, computers or smart aps.

peakless insulin

lantus

theories of aging from Havighurst

later maturity task -disengagement from the task of middle age. This allows involvement in new roles such as grandparent and friend, Adjust to changes in health, retirement, loss of spouse, affiliation with one's own group, new living arrangements.

At 4 months old, an infant can

laugh, voice vowel and some consonants, repetitive babble

The chief nurse manager role is to provide

leadership through a vision of the potential capabilities of the unit

Which hemisphere of the brain controls language functions or linguistics?

left hemisphere

clincial manifestation of right hemisphere stroke

left-side paralysis, DIFFICULTY WITH;depth perception, impulsivity, geographic memory,balance,unilateral neglect, somatagnosia, inappropriate behabior, figure ground deficits, dressing problems,egocentricity

central cord syndrome

lesion in cervical region, damage to central part of spine, greater weakness in ue comapted to le, sacral sensory sparing, hyperextension or flexion in cervical region, bladder dysfunction

adolescence 13-9 years old

let them make decisions about their care, respect privacy, encourage friends and peers to visit

pharm interventions for parkinsons

levodopa,antiviral,anticholernig and catechol-0-methyltransderase inhibitor

Milieu therapy includes

light-hearted atmosphere among the rehab nurses and patients, availability of resources and activities, pleasant use of sounds such as piped in music, tone of voice

goals and interventions for gbs

limit pain and discomfort, maintain function in unaffected limb and limit atrophy to affect limbs, maintain oxygen and effective breathing, manage autonomic dysfunction, maintain nutritional support,effective communication, maintain skin integrity,prevent dvt, maintain B&B, provide environmental control, NOTE-strength returns in descending pattern

acute

localized pain,fast a-delta fibers

Skilled nursing facility (SNF)

long tern care, clients called residents,

change in weight

loss in type 1 gain in type 2

Ataxia

loss of ability to coordinate muscle movement

Complete spinal cord injury

loss of both motor and sensory function in the lowest sacral segment / 2-3 segments below lesion retain partial function

Mild brain injury

loss of concious <30min GCS 13-15 negative neuroimaging

Subluxation

loss of normal muscle tone in deltoid and supraspinatus, painless but when manipulated in improper position will cause pain

hyperphagia

loss of satiety / feeling full

Inadequate intake of protein, vitamin C, thiamine, and zinc (poor nutrition) place the client at risk for

loss of skin integrity

Asnomia

loss of smell

Impairment

loss or abnormality of psychological, physiological or anatomical structure or function

Maslow presented family, work, and community involvement as examples of which need

love/belonging

Medicaid is the health insurance program for certain individuals and families with

low income

Subacute Care

lower cost option for rehab care, for pt who cannot tolerate 3 hours of therapy per day,

fidelity

loyality fairness, truthfulness, advocacy, and dedication to our pateints

nursing intervention for swallowing problems

lung assessment before and after meals, seat upright position 90degrees, mininal distractions, discourage talking during meals, stay with one food and texture at a time, do not mix solids and liqids, teach alternate and solid mouthfuls,meds in pudding or yogurt

lymphoma

lympahtic system cancer

Independence can be fostered when people with disabilities are

made responsible for self care and expected to participate in family roles.

Nurse managers respsonsibilities include

maintaining standards of practice, competency, care, accreditation, operating budgets, staff developement, human resources

Quality is defined as

maintenance of the highest and finest standards

Situation ethics promotes

making the best decision given the specific circumstances.

treatment of dilated cm

management of hf, anticoagulation, heart transplantation

What is included in the American with Disabilities Act of 1990?

mandates 24 hour relay services by telephone companies so that individuals with telecommunication devices for the deaf could communicate with those who do not have those devices

Personal competence with coping in regards to productivity involves

manifesting competence

hypothalamus

master controller for the ANS, produces two hormoneswhich are stored an released from the pituitary gland( ADH and Oxycontin)

Multidisciplinary model

may be seen in rehab is one that takes on a pyramid-like shape. Physician at tip, however Lydia Halls model implemented at the Loeb center put nurses at top. Communication more vertical than lateral with leader controlling team conferences. Effective when team is not stable (different team members for different clients)

contemplation

maybe next month

Which team model is UNCOMMON in rehab practice?

medical

The National Quality Forum (NQF) states the major areas of concern in the health care setting are

medical errors, overtreatment, undertreatment.

treatment/mangement for asthma

medicatiions,maximize breathing,pace activities,reduce airway secretions,inflammation&bronchospams,maintian/improve nutritional status,identify irritants,smoking cessation, mechanical ventilation,peak flow meter, education

treatment of hypertrophic cardiomyopathy

medication-beta blockers,calicum channel blockers, anti-dysrythmic therapy, myotomy,pacemaker,automatic implntable cardioverter defibrillator

types of cancers that are increasing

melanoma,non Hodgkins lymphoma,childhood cancers,leukemia anc cancers of the kindney,thyroid,pancreas, liver, testis and esophagus

Rancho V

memory starts to improve

Holistic nursing takes the whole person into account including

mind body and spirit.

Lawrence Kohlberg & Carol Gillgan both developed theories of

moral development

3 and 4th ventricle

more centrally located, allows csf to continually flow from the brain to the spinal cord

symptoms of MS

motor loss resulting in weakness,tremors,knee locking,contractures,gait issues ataxia,Uhtoffs phenomenon,facial palsy, hyperactive brain stem-double vision, decreased vision field, dysphagia Elimination-urine freq,

Gullain-barre syndrome

motor weakness that ascendidng, symmetrical,flaccid paralysi,respiatory insufficieny, cranial nerve involvement,loss of nerlogical funcion and deep tendon reflex,weakness/fatigue in face,arms,neck,back and thoracic muscles

shearing

movement of muscles,tissue downward and compression against the bony skeleton / occurs when client sits in bed and slides down.

In which rehabilitaitonteam model is communication more vertical than lateral, with the leader controlling team conference?

multidisciplinary model

What is a major difficulty with mechanical embolus clot removal?

must be in an accessible location

1990 Self Determination Act

must have Advance Directive copy in charts, Educate pts on their rights

mg crisis

myasthenia crisis,cholinergic crisis

The most popular complimentary and alternative medicines (CAMs) are

natural products, deep breathing/meditation, and chiropractic.

What area of the body is at risk of occlusion of two major arteries?

neck - internal carotid and vertebral

Internal barriers for community reentry include

negative attitudes, poor self esteem, lack of motivation, poor self image, and feelings of dependence.

total person systems

neuman

secondary symptoms

neuropathy,renal dysfunction, esrd,erectile dysfunction,retinopath, peripheral vascuale disease in capillary beds

Exacerbation

new or worsening symptoms lasting more than a week

vegetative state

no distinct evidence of conscious awareness of self/environ eyes open spontaneously, SW, no intentional, purposeful, reproducible reponses to stimuli

NPO is the most restrictive diet, it means

nothing by mouth

intermediate acting

nph or L

medications or HIV

nucleoside analog reverse transcriptase,non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, fusion inhibitors,HAART therapy

The four concepts considered as the broadest perspective of the nursing profession include

nurse, patient, health, and environment.

Pre Albumin

nutritional status

When assessing a client's social support the nurse should

observe for barriers such as fatigue, isolation, lack of self confidence. Note the frequency of contact with family and friends, and the participation in leisure and physical activities. Patterns of behavior such as alcohol use after injury should be assessed.

Assessment of a family's psychological health includes

observing the family members' communication, cohesiveness, planning strategies, actions and behaviors

Upper Motor Neurological Bladder and Bowel

occurs at central nervous system from c1-t12, spastic paralysis and relexive muscles

lower motor neuron bladder and bowel

occurs below L1 and affects the peripheral nervous system, faccid spincters, no reflexes

Case management is the process

of assessing, planning, organizing, coordinating, implementing, monitoring, and evaluating the services and resources needed to respond to an individuals healthcare needs.

Problems related to sexual disinhibition or impulse control include

offending the uninjured partner, increasing the number of sexual partners, or show inappropriate public displays of sexual impulses or activity.

2 lateral ventricles

one in each hemisphere,csf formed

HIV

onset 0-12 weeks,virus infects wbc cd4+T cells, tests-Elisa,antigen,viral loads

What is the ideal time to involve the external case manager?

onset of the disability

Independent living

opportunity to share activities of daily living with other residents,

Phases of Swallowing

oral preparatory phase, oral propulsive phase, pharyngeal phase, esophageal phase

general theory of nursing theorist

orem

The Case manager acts in the best interest of the client to

organize, coordinate, and promote services and obtain client goals.

Injury T6 and above

orthostatic hypotension / temperature regulation / AD

treatment of chf

pacemaker,Lvad,cardiac transplantation,medication-diuretics,ace inhibibitors,digoxin,oxygen

nurse view on pain

pain is whatever the experiencing person say it is, exisiting wherever he says it does,

surgery options for parkinson

pallidotomy &thalamotomy deep brain stimulators which have electrical pulses in the brain

impact of disability on parents when a infant to 1year old is hospitalized

parents dream of having a perfect child is affected parents deal with seperation and bonding is interruped. parents feel guilt and sorrow BUT child adjust fairly well

reasons for incontience

pathological factors, anatomical factors, postmenopausal women, men with bph, cognitive dysfunction, MS,Parkinson, Stroke

3 Important concepts for rehab nursing

patient centered, goal-oriented, outcome-based

Ineffective community therapeutic regimen

pattern of regulating and integrating into community processes programs for treatment of illness that are unsatisfactory for meeting health related goals

Ineffective family therapeutic regimen management

pattern of regulating and integrating into family process that is unsatisfactory

Prospective payment system

payment rate to the healthcare facility is predetermined based on the medicare diagnosis

Bandura's Learning Theory of Self Efficacy

people learn from one another, via observation, imitation, and modeling.

Expected client outcomes related to sexual function include

personal satisfaction with sexual function, avoidance of sexually transmitted diseases, pregnancy when desired and possible or the avoidance of if not desired, and the ability to plan and carry out parenting roles if appropriate.

This branch of psychology investigates human nature and individual differences.

personality theory

Community reentry and assisted care living facilities

personalized 24 hours assistance and support,

Cardiac Rehabilitation Four phases

phase 1-inpatient telemetry unit, goal is the minimize damage phase 2-restoration day1 thru discharge goal-hemodynamic stability,regulate meds,educate,exercise, monitor phase3-outpt supervised program 2-12 weeks gaol-increase endurance,home exercise program,educate, decrease risk factors,resume sex phase 4-life long changes to improve endurance and fitness

neuromatrix theory

phathom pain, no cause, cns-built in body self neuromatrix generate nervee impulses that represnt the multidimensional somatosensery experience activate peripheral ssensory stimulation or by brain process to produce persistent pain

Stressors that affect men after a spinal cord injury (SCI) include

physical abilities, health and finances.

A device or equipment that the client cannot remove easily and that restricts his or her freedom of movement

physical restraint.

Lap belts, vests, geri-chairs, trays, bed rails, and door alarms all may be classified as

physical restraints.

The effects of stress are expressed...

physically, emotionally, intellectually, spiritually and socially.

Maslow's Heirachy of needs consists of 5 categories, name them.

physiological, safety, love/belonging, esteem, self actualization.

layers that protect the brain

pia mater,archnoid mater,dura mater

Symptoms of dysphagia include

pocketing food, leakage, delayed or prolonged swallowing, frequent pneumonia, malnutrition & weight loss.

primary s/s of diabetes

polyuria polydipsia polyphagia also poor healing, freq infections, fatigue

The best way to prevent pressure ulcers is by

positioning and repositioning the client's body, encouraging weight shifts every 15 minutes & providing proper seating.

s/s of autonomic dysreflexia

pounding headache,hypertension, bradycardia, flushing and profuse sweating above level of injury, piloerection, nasal congestion above level of injury, below injury-cold,pallor impending sense of doom

What is deontological theory

practice based on the ethics of duty and respect is more oriented toward what is defined as right in a legal sense.

Interventions for Diabetes

practice insulin admin,skin checks, exercise,150 min/wk moderate aerobic exercise,

Transtheoretcial model of change

pre-contemplation, contemplation, preparation, action, maintenance, transformation

incomplete injury

prescence of partial preservation of sensory or motor function below the level of injury

The Braden scale is used to assess

pressure ulcer risk

The nurse should encourage good skin care, manage incontinence, and encourage healthy nutrition to help prevent

pressure ulcers

In assessing an individual's coping effectiveness, the nurse should ask about the person's

previous lifestyle

Apraxia

problem with motor movement, motor planning

liver

produces albumin

Syndrome of inappropriate diuretic hormone (SIADH)

produces too much ADH = fluid retention and edema / meds = high salt diet

Wernicke's aphasia is marked by

production of verbal language, but the language is meaningless; fluent speech that may have incorrect words& context and the client is unable to detect errors.

Rehabilitation Act of 1973

prohibits discrimination on the basis of disability in programs conducted by Federal agencies, in programs receiving Federal financial assistance, in Federal employment, and in the employment practices of Federal contractors.

The nurse manager is responsible for

promoting and disseminating information about the values and objectives of the nurses.

Which method of paying health care providers shifts part of the financial risk to hospitals by paying a fixed amount based on admission diagnosis?

prospective payment

tissue cells release chemicals that stimulate pain process

prostaglandins,histamine, bradykinin,serotonin, substance p

meinges

protective coating for the brain and spinal cord

Nursing interventions for ineffective coping should include:

providing support that enhances the ability to cope, make decisions, control anger, build self esteem and enlarge support system

What are the two PRIMARY goals of the interdisciplinary team in pediatric rehabilitation?

provision of care and self-maintenance

cultural negotiation model

pt is seen as the expert in the knowledge of their condition. the rn interacts with the patient to develop to manage their pain

National Dysphagia Diet (NDD1), Dysphagia pureed allows clients to eat

pudding like consistency foods.

dysphagia pureed

pudding like no chunks, avoid lumpy foods and small pieces

Pupil response

pupils < or = 8 is coma;

Three things to include in any pain assessment are

quality, location and radiation

The commission on Accreditation of Rehabilitation Facilities (CARF) seeks to promote

quality, value and optimal outcomes of services through a consultative accreditation process.

Quality measure

quantification of the degree to which a desired healthcare process or outcome is achieved

short acting

r insulin

Dysphagia can be caused by

radiation treatment, stroke, dementia, myasthenia gravis, and Amyotrophic lateral sclerosis (ALS).

Amyotrophic Lateral Sclerosis (ALS)

rapid destruction of motor neurons in the brainstem and spinal cord

What is the role of an interdisciplinary team?

reach a common goal thru team meetings and go beyoud their respective disciplines

What is a SMALL number of people with complementary skills who are equally commited to a common purpose, goals, and working approach known as?

real team

parietal lobe

receives and inteprets sensory input,pain temp, pressure,size,shape,spatial orientation

occupital lobe

receives and interprets visual,depth perception

Personal competence with coping in regards to love involves

receiving affection, and being compassionate, accepting and giving.

Which member of the rehab team has the PRIMARY responsibility for assisting pts. in gaining skills for community reentry?

recreational therapist

treatment for chronic bronchitis and emphysema

reduce airway secretions,reduce inflammation, decrease bronchospasm,medications,hest physiotherapy

CARF accredits which type of programs?

rehab programs

Societal barries for community reentry may include

reimbursement issues, ineligibility for services, cultural or attitudinal prejudices, and social stigmas.

Factors that influence personal competence with coping are

relationships, differentiation, autonomy, self-esteem, power, productivity, and love.

Self-hypnosis, prayer recitation, deep-breathing, muscle relaxation are types of

relaxation exercises

Personal competence with coping in regards to autonomy involves

relying on self separate and distinct form others.

Prospective memory

remembering to do something in the future

Education for all Handicapped Children Act 1975

required public schools accepting federal funds to provide equal access to education for children with physical and mental disabilities

Affordable Care act

requires people to have health care insurance

The National Center for Complimentary and Alternative Medicine (NCCAM) is a federal agency that funds

research on complementary and alternative medicine (CAM)

A closely knit group of patients sharing support services is a

residential facility

Which initiative was developed by Medicare to reimburse physicians under the Omnibus Budget Reconciliation Act of 1989?

resource-based relative value reimbursement

Pharyngeal Phase

respiration is inhibited . trachea is coved by epiglottis

Goal of rehabilitation

restore,maintain, and promote maximal health

The goal of rehabilitation is

restoring, maintaining, and promoting maximal health.

Interventions to assist clients with sexual relationships if they experience bladder dysfunction include

restrict fluids before sexual activity and complete toileting. if foley catheter present it can be taped to the side (for men a condom may be placed over the shaft of the penis) avoid positions

Disability

restriction of the ability to perform and activity in the manor considered to be normal. (personal level)

cholinergic crisis

resulsts from excessibe dosage of cholinergic treatment meds s/s-salvation, lacrimation, urinary incont, GI upset,miosis, flaccid paralysis, resp failure

To assess the client's fall risk....

review the fall history, medications, assess gait and balance, identify mobility aids needed

clinical manifestation of left hemisphere stroke

right side paralysis, DIFFICULTY WITH :math problems , symbolic interpretation, speech and language deficits, analytic thinking, hesistant behavior,

Social manifestations of stress include

role conflict, status incongruity, withdrawal, antagonism, or role rigidity.

hemmorrhagic stroke

rupture of blood vessel in brain

Maslow presented shelter, job security, and monetary security as examples of which need

safety

concerns of using opiods

safety concerns, n/v, constipation,drwsiness with sedation, interactions with other medications

Expenses include

salaries, fringe benefits, staffing requirements, supplies, rental equipment

Deep tendon relex

score of 2+ is normal

In the holistic nursing concept a client is

seen as one with the universe and is an energetic being manifested as frequencies or energy waves.

Imogene King

sees nursing as an interactive endeavor in which nurse and client share information in the nursing situation

Positive thinking, satisfaction at small successes, and interest in appearance are all evidence of

self -concept adjustment

Avoiding, neglecting, or refusing to recognize personal assets are evidence of

self -diminution

A person's sense of personal value and ability to consider himself/herself with dignity, love, and reality. It affects the inner person and the person's relationships with others. It is based on a personal evaluation of self worth and competence.

self esteem.

A person's perception of himself/herself as related to others and the environment that addresses all aspects of the person is referred to as

self-concept.

Negative thinking, and expectations of failure are evidence of

self-criticism

wellness is defined by the holistic concept as a

self-directed quest, for optimal well-being along a multidimensional continuum of mind body and spirit.

Which attribute or trait is a characteristic of a change-resilient person?

self-discipline

Which theory did Bandura deveklop to guide the assessment of the individual's ability to promote health and reduce risk?

self-efficacy

Piaget's stages of development

sensorimotor-up to 2 years in which senses guide the child preoperational-2 to 7 ears child and fantasy concrete operations-starts at age 7 formal operations-age 12-18,lack of judgement and are egocentric

The six components of the braden scale include

sensory (ability to respond meaningfully to pressure related discomfort), moisture (the degree to which skin is exposed to moisture), activity (degree of physical activity), mobility (ability to change change and control body position), nutrition (usual food intake), and friction and shear (stability of movement in a relaxed position, such as in a bed or chair).

What blood tests indicate nutritional status?

serum albumin, hemoglobin, hamoglobin A1c, and prealbumin.

Components of individual goal setting include

set on admission, individualized & realistec, reviewed and updated regularly.

Which christian sect maintains Saturday as the holy day?

seventh day adventist

Americans With Disabilities Act 1990

signed into law under President George H W Bush. It applies to all private and state-run businesses, employment agencies to make sure that no person with a disability is turned down for a job or promotion, or refused entry to a public-access area.

carcinoma

skin cancer

The two most common sleep disorders in the Rehabilitation client are

sleep apnea and narcolepsy

Parasympathetic Nervous System

slows heart rate / lowers BP / increase GI activity / shunts blood to major internal organs

Stress incontinence is defined as

small lossess of urine that occurs when the intra-abdominal pressure is increased by activities such as coughing, laughing, exercising, or sneezing.

modified risk factors for chd

smoking,htn,cholestrol,dm,sedentary lifestyle,alcohol,obesity

In the integral nursing theory the collective exterior domain is known as the "Its" space. It includes

social systems and structures, networks, organizational structures and systems, information technology, regulatory structures.

National Dysphagia Diet (NDD2), Dysphagia mechanically altered allows clients to eat

soft moist foods

mechanical soft

soft moist ground meats and soft vegetables and bread, cakes and rice

dysphagia mechanically altered

soft moist ground meats and soft vegetables, no breads, peas or corn, avoid skins and seeds

Limited information as defined in the PLISSIT model of sexual counseling would include

some specific information related to questions raised or concerns expressed and allowing the person to pursue the issue further if her or she is comfortable.

precontemplation

someday

Multiple Sclerosis

spacticity ans spastic paralysis / upper motor neuron disorder / demyelination / cranial nerve II (optical) / cranial nerve III (occulomotor) / blurred vision / blind spots / double vision

Name three classifications for neurogenic bladder

spastic bladder, flaccid bladder, and overactive bladder.

sci

spinal cord injury

spina bifida

spine does not closee properly known as neural tube deficit

NON -Rem Stages

stage 1 bried transitonal sleep, stage 2 is deeper sleep, stage 3 a&4 is the deepest sleep

Rebound occurs when an individual spends insufficient time in certain stages of sleep. For which of the following stages is rebound an IMPORTANT concept?

stage 4

Rancho VI

start using memory systems such as cueing and repetition

Medicaid is federally funded but

state administered.

Imogene King

states that a person has intrinsic worth

Imogene King

states that the goal of nursing is to help individuals maintain their health so they can function in their roles

The application of set attitudes about and stereotypes of people with disabilities.

stigma

Autonomic Dysreflexia is caused by

stimulation below the level of injury, also known as hyperreflexia.

Inpatient Rehab Facility

stoke, trauma, tbi, spinal cord, CARF, 3 hours of skilled rehab therapy a day for 5 days,

What is the leading cause of adult long term disability in Canadians?

stroke

persons who may have swallowing difficulties

stroke,brain injury,parkinson's, MS,ALS, MD, pollomyelitis,radiation treatment, worsening dementia

SAH

subarachnoid hemorrhage-rupture of blood vessel w/in subarachnoid space

Rehabilitation clients need adequate nutrition to

support healing and meet metabolic demands as the diet changes during acute and chronic illness or disability.

treatment of reflex neurogenic

suppository,digital simulation,sit on commode

Overactive bladder (detrusor hyperreflexia without detrusor sphincter dyssynergia) is often seen with

suprapontine lesions from other cerebrovascular diseases.

Dysphagia is

swallowing difficulty during the passage of a solid or liquid bolus from the mouth to the stomach.

diagnosis of cystic fibrosis

sweat test

s/s of chf

swelling of the legs,ankles and abd d/t to build up of fluid s.o.b. during rest or exercise,persisent cough-often produces mucus or blood-tinged sputum,decreased ability of kidney to remove sodium abd water, fatigue, weight gain,loss of appetite and nausea

non-insulin injectables

symlin,byetta

Severe constipation is defined as constipation that causes

sympathetic systemic problems (e.g., sweating, nausea, irritability, acute abdominal discomfort, and elevated blood pressure.)

Chronic constipation is defined as

symptoms lasting longer than 3 months, with enlargement of the descending colon and dependency on laxatives, cathartics, or enemas.

type of ischemic stroke

system hypoperfusion-known as watershed stroke, caused by inadequate cardiac output with system

cancer staging methods

t-tumor n-node involvement m-metatistic

A partner of a client with neglect or denial of deficits related to sexual relations should

take a more active role and gently redirect the injured partner, use positioning with pillows or alternate positions.

Holistic nursing includes any form of nursing that

takes the whole person into account including mind, body, and spirit. In holistic nursing this is the bio-psycho-social-spiritual framework

In the interdisciplinary team model

team decisions are determined by the group working directly with the client.

What is the process of aligning and developing the capacity of a team to create the results its members desire?

team learning

Global Aphasia

temporal lobe damage / impaired reception and expression of speech / written info is limited

Which level of wellness views rehabilitation activities and the monitoring of health care processes to prevent complications or further illness, injury or disability?

tertiary prevention

Section 504 of the Rehabilitation Act requires

that all buildings and facilities are designed, constructed, or altered to accommodate physical disability.

Provisions 1,2,and 3 of the ANA Code of Ethics says

that the nurse should provide services in a manner that respects human dignity, that the nurse's main committment is to the patients and should act as an advocate

The structure that can be enhanced to create more integral awareness and partnerships to achieve health and healing both locally and globally is known by the integral nursing theory as

the "Its" of the collective exterior domain

Barbara M Dossey is credited with developing

the Integral Nursing Theory to support holistic nursing.

The multidimensional acceptance of loss scale developed by James Ferrin evaluates

the ability of a client to enlarge the scope of values, contain the disability, subordinate the physique, and change comparative status values to asset values.

Helplessness is

the belief that a person is dependent on others for support for a situation that seems to be impossible to change.

Stress is defined as

the cognitive awareness of any external or internal unmet demands that unbalance a person's equilibrium.

Self-efficacy is an important concept in relation to changing health behaviors. Which statement BEST describes self-efficacy?

the degree of confidence a person has about his or her ability to perform a specific activity

The ARN definition of rehab nursing is

the diagnosis and treatment responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle.

What is nonmaleficence?

the duty to do no harm

Duty ethics is a form of ethics that believes

the end justifies the means.

Motor Paralytic bowel impairment is defined as

the inability to assist with defecation and is associated with incontinence only if there is widespread disease due to the innervation of the intestines.

Define disability

the inability to perform some key life function

In the integral nursing theory the individual interior domain is known as the "I" space. It includes

the individual's inner experiences, and states of mind.

Define handicap

the interaction of a person with a disability with the environment

Which ascending spinal cord tracts is responsible for transmitting pain and temperature sensations?

the lateral spinothalamic tract

The assessment for how well a client is coping with diagnosis should include

the level and sources of stress expressed by the client and family, the client's ability to solve problems, changes in the client & families ability to meet their needs.

what is diaschisis

the loss of brain function in regions connected to, but at a distance from the infarction

Define functional limitation

the loss of the ability to perform self-care tasks and is the result of an impairment

Functional incontinence is defined as

the loss of urine and/or stool that is not caused by the GU/GI system, but rather something outside these systems.

Urge incontinence is defined as

the loss of urine caused by abnormal detrusor contractions, sometimes associated with urinary retention.

Overflow incontinence is defined as

the loss of urine caused by bladderoverdistention or retention.

According to the World Health Organization (WHO) Impairment is

the loss or abnormality of a psychological, physiological, or anatomical structure and function.

In the integral nursing theory the individual exterior domain is known as the "it" space. It includes

the material body, integral patient care plans, skills development, behaviors, leadership skills, integral life practices, and anything we can touch or observe in time and space.

Knowledge of a client's cultural practices includes

the meaning of touch, personal spatial and distancing, and the use of eye contact.

Provision 5 of ANA Code of Ethics says

the nurse has a committment to self as well as in terms of maintenance of integrity and personal and professional growth

Provision 4 of ANA Code of Ethics says

the nurse is responsible and accountable for individual nursing decision and actions

Homebound status means

the patient is unable to easily leave home alone or with assistance,requires skilled care at home and has no other readily accessible options to address these needs.

Acute constipation is defined as

the recent onset of symptoms, a large amount of stool in the rectal ampulla, colon, or rectum.

Which of the following defines impairment?

the residual limitation that results from disease, injury, or a congenital defect

Post traumatic stress disorder (PTSD) is defined as

the state in which an individual experiences a sustained painful response to one or more overwhelming traumatic events for more than 1 month and is unable to assimilate the memory of the event.

transformation

there is no going back

risks factors affecting fall in the eldery

think Crashed C for cords, carpets,cracks R for Rx-drugs A-affect( depression) S- for Sickness H for Hypotension E for Eyes D for Dizziness

What is the purpose of the Glascow Coma Scale?

to access for LOC

Why was the Nuremburg Code established after WWII

to address human medical experimentation and is now the basis for clinical research guidelines

Why should arms be positioned correctly with splints a

to avoid subluxation

The general goals of Cardiac Rehabilitation are

to reduce or minimize further complications, promote a healthy heart lifestyle, and improve cardiac function.

complete injury

total loss of sensation and motor function below the level of injury

management gbs

total plasma exchange,IV Immunoglobulin, medication to assist with complication

Nonverbal communication is the

transmission of message without the use of words.

clinical manifestation of Parkinson Disease

tremors,pill rolling of thumb and finger, muscle rigidity,fressing episodes, abnormal muscle stifffness, inability to change movement, slowness, no arm swing, shuffling gait, drooling and swallowing problems,small handwriting

Required components necessary for self-maintenance of a team include

trust, knowledge, shared responsibility, mutual respect, communication, cooperation and coordination and optimism.

long acting

ultralente (u) insulin

kurt Lewins

unfreezing, change, refreezing Motivation to change, change sense of stability

Overflow incontinence is characterized by

urgency, frequency, dribbling, and both stress and urge incontinence.

stepwise approach to pain

use mild apprach using nsaid then moderate to severe pain uses opiod

multimodal analgesic approach

use of aduvant medication- anticonvulsants,nsaidsand antidepressants for neuropathic pain

early childhood 3-6 years old

use play therapy, focus on abilites not disabilites

posterior spinothalmic tract ascending

used for bladder fullness pain and temp which sends message to cerebral cortex to the sensory strip then to the inhibitory center in the temporal/frontal making the brain aware of the full bladder

A chemical restraint is a medication

used to subdue or quiet behavior

Personal competence with coping in regards to power involves

using energy to initiate and guide behaviors

Polypharmacy

using two or more drugs to treat the same condition / using more medications than are clinically indicated in a given client

Spiritual signs of stress include

value conflicts

What is ischemic penumbra?

vessels nearby a blocked vessel will immediately start to sprout new capillaries to try and salvage tissue and maintain blood supply

The adaptation of an existing family intervention for a chronic condition that focuses on enhancing both individual and family functioning is useful for working with

veterans and others with traumatic brain injury (TBI)

Martha Rogers

views human beings as wholes not parts

Martha Rogers

views nursing as "knowing rather than doing"

Margaret Newman

views the meaning of life and health in terms of an evolving process of expanding consciousness

Imogene King

views the person as an open system

ways to rate pain

visual analog scale(VAS),numeric rating scale (NRS),Wong Baker-Face Scale

Nonverbal communications may include

vocal tone, eye contact, physical appearance, gestures, and posture.

Stress incontinence is caused by

weak external sphincter, weak pelvic floor musculature, and secondary effects of smoking and obesity.

nursing interventions for wounds and pressure ulcers

weight shifting, float heels,manage incontience, cushions, minize moisture

Factors of social interaction with family and friends as well as environment can influence

wellness of the mind, body, and spirit.

Rebound occurs:

when an individual is deprived of Stage 4 sleep

Kurt Lewin's Change theory includes three stages of change. Stage 3 " refreezing" includes

when the change is established.

Kurt Lewin's Change theory includes three stages of change. Stage 1 "Unfreezing" includes

where one lets go of old patterns

The Frazier water protocol administers medications

whole or crushed in applesauce, pudding, yougurt, or thickened liquid, never thin water.

Overactive Bladder

without detusor sphincter dyssynergia

In a multidisciplinary team model professionals

work in parallel towards their disciplines specific goals with very little overlap. Goals are set by a team representative.