Nu 300 exam 1

What IS patient centered care?

"to be competent in patient-centered care, the nurse recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs" QSEN

What is the nurse's role in surgery for patients with Cancer?

-Coordinate care -Encourage patient to express their feelings -Encourage patient to look at and touch the operative site -Encourage patient to participate in care - dressings for example -Provide support group contact for patients and families -Have some who has coped with the same issue come for a visit -Referral to a mental health care provider may be needed if the patient has persistent depression -Develop exercise regimes to maintain strength and function -Find and encourage support for psychosocial aspects to include support groups, survivors, mental health care providers -Physical therapy -Spiritual care

Describe the steps in developing cultural humility

1) Maintain lifelong learning: Be curious about your clients and their lives. 2) Engage in continuous self-reflection: Become aware of your personal history and biases in an effort to become conscious of the assumptions you hold about people from a given group. 3) Become comfortable with "not knowing": It is impossible to know everything about another person or another culture. 4) Recognize there may be power/privilege dynamics: Power dynamics can generate distance between you and your clients.

The homeless avoid the health care community because:

1) Mistrust of health care providers 2) Fear of discrimination 3) Language barriers 4) Inability to understand medical information 5) Inability to adhere to treatment

What are core measures?

Developed by the Joint Commission to improve quality of health care by implementing a national standardized performance measurement system Measures are focused on patients with the following medical diagnoses: -Acute myocardial infarction -Congestive heart failure -Community-acquired pneumonia -Surgical infection prophylaxis -Pregnancy-related conditions -Deep vein thrombosis

Cultural diversity:

Differences among people which may or may not be visible

Describe health disparities

Differences in patient access to or availability of appropriate health care services

Health disparities:

Differences in the incidence of health problems in minority groups compared to the majority.

Cognitive Function

Difficulty concentrating Difficulty learning new information Memory loss May last for a few years after Chemotherapy ends Idiopathic - structural changes do occur in the brain and are usually gone by 3 years after Chemotherapy ends Priority Nursing interventions are directed toward supporting the patient -Listen -Reassure others have had the same experience and it is temporary -Discourage activities that impair cognition

Alopecia

May be only thinning → full body loss. Temporary and grows back beginning about 1 month after Chemotherapy stops. New hair may be different in texture, color, & thickness. Cannot be prevented if the chosen drug causes it. The priority nursing interventions are directed at protecting the scalp from injury. -Sunscreen -Head coverings that are soft and pleasing to the patient -Caution is using headphones, helmets, head sets, etc Cutting hair before Chemotherapy allows for a better wig fit. Getting the wig before chemotherapy gives the hair dresser the chance to make a wig resembling the patient's hairstyle. American Cancer Society will loan wigs

Identify Primary Prevention strategies for cancer.

Modify lifestyle to avoid -Sun -Tobacco -Asbestos High fat low fiber diets -Multiple sexual partners -Processed meats Remove at risk tissues -Moles -Polyps -Breast -Ovaries Vaccination -Gardasil Chemoprevention -experimental at this point Genetic testing -only identifies risk

Describe the advantages and disadvantages of oral chemotherapy.

More convenient Misperception they are less toxic by patients and healthcare workers Control of treatment is lost -Protection -Compliance -Correct administration -Recognition and management of side effects Cannot be crushed, split, broken or chewed

Madeline Leininger:

Nurse anthropologist that provided knowledge on transcultural nursing.

Who is qualified to administer chemotherapy?

Nurses who are specialized in chemotherapy

How is Photodynamic therapy implemented?

Patients are given IV medications which deposit in all cells but dissipate from normal cells in a couple of days (2-3 days). After the dissipation time, the patient receives laser therapy which destroys the cancer cells with the medication still present. Patients have marked photosensitivity for 12 weeks following therapy and should be instructed on how to protect from light and to remain homebound for 3 months.

Thrombocytopenia

Platelet counts <50,000/mm3 leads to prolonged bleeding Platelet counts < 20,000/mm3 leads to spontaneous and uncontrollable bleeding Oprelvekin (Neumega) may be used to stimulate production of platelets Neumega side effects -Fluid retention -Congestive Heart Failure -Pulmonary Edema -Conjunctival bleeding -Hypotension -Tachycardia -May stimulate the growth of some cancers

What is clinical judgment?

Process of making decisions based on interpretation of the patient's needs or problems

What is QSEN?

Quality and Safety Education for Nurses

Cultural competence:

Respecting all differences and not letting one's biases influence others.

Identify Secondary Prevention strategies for cancer.

Screening is key as early detection = better outcomes Mammography (40+) Breast and testicular exams Colonoscopy (50 then every 10 years) Yearly fecal occult blood for all adults Yearly PSA and rectal exam for males over 50

Describe the steps of SBAR communication

Situation-Briefly describe the situation Background-Briefly state pertinent history Assessment-Summarize the facts Recommendation-What are you asking for? What needs to happen next?

Utilatarianism

actions that are right when they contribute to the greatest good

Ethnicity:

common social customs, values and beliefs of a group. Not race.

What health problems may individuals with dwarfism encounter?

• Common health problems: arthritis, hydrocephaly, ear infections, obesity, spinal stenosis, menstrual complications, reduced fertility, fibroids, early menopause. • Common surgeries: Myringotomy, spinal fusion, laminectomy, joint replacement, osteotomy, leg-lengthening surgeries, etc. • High risk for falls. • Provide adaptive resources (footstools, reaching tools, etc.)

Review the Joint Commission National Patient Safety Goals:

1. Identify patients correctly: • Use at least two ways to identify patients. For example, use the patient's name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment. • Make sure that the correct patient gets the correct blood when they get a blood transfusion. Improve staff communication • Get important test results to the right staff person on time. 2. Use medicines safely •Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. •Take extra care with patients who take medicines to thin their blood. •Record and pass along correct information about a patient's medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor. 3. Use alarms safely •Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. •Use the goals to improve hand cleaning. Use proven guidelines to prevent infections that are difficult to treat. •Use proven guidelines to prevent infection of the blood from central lines. •Use proven guidelines to prevent infection after surgery. •Use proven guidelines to prevent infections of the urinary tract that are caused by catheters. 4. Identify patient safety risks •Find out which patients are at risk for suicide 5. Prevent mistakes in surgery •Make sure that the correct surgery is done on the correct patient and at the correct place on the patient's body. •Mark the correct place on the patient's body where the surgery is to be done. •Pause before the surgery to make sure that a mistake is not being made.

How should body fluids from patients receiving chemotherapy be handled?

Anyone preparing, giving, or handling chemotherapy drugs or handling excreta from patients receiving chemotherapy should wear PPE (Eye protection, Double gloves or chemo gloves, Masks, Gown)

What is stereotyping?

Assuming that all people from a particular culture are the same.

2. Know the components and definitions in the ASKED model of cultural competence

Awareness: Are you aware of your personal biases and prejudices toward cultures different from yours? Skill: Do you have the skill to conduct a cultural assessment and perform a culturally based physical assessment? Knowledge: Do you have knowledge of the patient's worldview(how a person looks at the universe to form values in their life and world)? Encounters: How many face to face encounters have you had with patients from diverse cultural backgrounds? Desire: What is your desire to want to be culturally competent?

How does the nurse recognize the following oncologic emergencies? o Sepsis o DIC o SIADH o Spinal Cord Compression o Superior Vena Cava Syndrome o Tumor Lysis Syndrome

Before Photosensitization -Bring protective clothing (e.g., shirts with long sleeves and high collars, long pants or skirt, gloves, socks, wide-brimmed hat) and UV-protective sunglasses with you when you come to be injected with the photosensitizing agent. -If possible, have someone else drive you home so that you can place a sheet or light blanket over yourself. -Plan to avoid leaving your home during daylight hours for anywhere from 1 to 3 months. -Cover all windows with light-blocking shades or heavy drapes/curtains. -Replace high-wattage light bulbs with lower-wattage ones, and use as few as possible. After Photosensitization -Remember that the photosensitizing effects last from 1 to 3 months. -Continue to wear all protective clothing, avoid sunlight in any form, and avoid high-wattage indoor lights. -Drink plenty of water to prevent becoming dehydrated. -Do not take any newly prescribed or over-the-counter drugs without contacting the physician who performed the photodynamic therapy. Some drugs make the light sensitivity even worse; others interact with the photosensitizing drug. -When you do start to re-expose yourself to sunlight and other bright lights, do so slowly. Start out exposing only about 1 inch of your skin to sunlight at a time -Start out with only 10 minutes, and increase the time only by about 5 minutes each day. -Remember that sunscreen will not prevent severe sunburn during this time. -If you experience pain or blistering, notify the photodynamic therapy health care team. -Continue to wear dark glasses, even indoors, until you no longer have eye pain when in a normally lighted environment. -When you no longer are photosensitive, see an ophthalmologist to check whether your retina has any damage

Differentiate benign and malignant cells.

Benign cells: -Maintain parent morphology -Maintain parent function -Maintain tight adherence/encapsulation -Do not migrate to other areas -Does not invade -Controlled growth rate -Most have 23 pairs of chromosomes -Smaller cell nucleus Malignant cells -Anaplastic growth - looses parent morphology -Loses parent function- cells have no useful purpose. -Loses adherence -Migrates and invades other tissues -Rapid and uncontrolled growth -Larger nucleus -Chromosomal abnormalities

What safety measures should be employed by nurses giving PO chemotherapeutic agents?

Cannot be crushed, split, broken or chewed Have the same PPE (Eye protection, Double gloves or chemo gloves, Masks, Gown) requirements as IV agents

Nausea and vomiting

Chemotherapy Induced Nausea and Vomiting (CINV) Begins with administration of the agent and may last up to 7 days following RX. Drug therapy for CINV is essential. Anxiety due to previous bouts of CINV may cause CINV Preventative meds should be given at regularly scheduled times before the CINV starts. Nurse's responsibility to ensure the meds are given before therapy begins Preventative meds will likely be given in combination therapy. Teach the patient as they wean themselves from the antiemetic drugs to resume at the slightest sign CINV is returning. Assess for dehydration, vomiting, and electrolyte imbalances Complementary measures to reduce CINV -Music -Progressive muscle relaxation -Guided imagery -Acupressure -Distraction -Concord grape juice before meals

Explain to the patient how chemotherapy treats cancer and affects non-cancerous cells?

Chemotherapy is systemic and kills cancer cells making it necessary for metastatic cancers. Chemotherapy also kills healthy cells, particularly rapidly dividing cells (skin, hair, intestinal tissues, sperm and blood forming cells) Chemotherapy may be used alone or as adjunctive therapy with radiation and/or surgery. Genetic therapy is available to help determine the most effective agents for patients.

Describe the process of quality improvement.

Continuous process using indicators (data) to monitor care outcomes and develop solutions to change and improve care

What are the risks involved in the use of informatics and technology?

•Patient privacy at risk •Photos of patients •Facebook and other social media

Explain to the patient how radiation works in cancer treatment.

Ionizing radiation is directed at the tumor to kill or halt mitosis of tumor cells. Cells in the path of radiation are destroyed. The best kill occurs in dividing cells. Exposure refers to the amount of radiation delivered,. Radiation dose refers to the amount of radiation absorbed. Radiation is given over multiple doses/days to increase kill.

What is the scope of adult health nursing?

Managing ACTUAL or POTENTIAL health problems affecting the individual, significant other, and community

Patient and Family Education: Preparing for Self-Management of a patient with neutropenia

During the times your white blood cell counts are low:•Avoid crowds and other large gatherings of people who might be ill. •Do not share personal toilet articles, such as toothbrushes, toothpaste, washcloths, or deodorant sticks, with others. •If possible, bathe daily, using an antimicrobial soap. If total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap. •Clean your toothbrush at least weekly by either running it through the dishwasher or rinsing it in liquid laundry bleach (and then rinsing the bleach out with hot running water). •Wash your hands thoroughly with an antimicrobial soap before you eat and drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. •Avoid eating salads; raw fruits and vegetables; undercooked meat, fish, and eggs; and pepper and paprika. •Wash dishes between use with hot, sudsy water, or use a dishwasher. •Do not drink water, milk, juice, or other cold liquids that have been standing at room temperature for longer than an hour. •Do not reuse cups and glasses without washing. •Do not change pet litter boxes. •Take your temperature at least once a day and whenever you do not feel well. •Report any of these signs or symptoms of infection to your physician immediately:•Temperature greater than 100° F. •Persistent cough (with or without sputum) •Pus or foul-smelling drainage from any open skin area or normal body opening •Presence of a boil or abscess •Urine that is cloudy or foul smelling or that causes burning on urination •Take all prescribed drugs. •Wear clean disposable gloves underneath gardening gloves when working in the garden or with houseplants. •Wear a condom (if you are a man) when having sex. If you are a woman having sex with a male partner, ensure that he wears a condom.

What growth factors are given in Anemia

Epoetin Alfa (Epogen and Procrit) Darbrpoetin Alfa ( Aranesp) Side effects are related to increasing all cell types -Hypertension -Hypercoagulability -Stroke -MI (heart attacks) -Promotes growth of some forms of cancers

Identify etiological factors of cancer. Who are the people at high risk for developing cancer?

Exposure to Carcinogens -Chemical -Physical -Viral -Dietary Genetic Predisposition Immune Function Chemical Carcinogenesis -80% of cancers in the U.S. are due to exposure to environmental factors -30% are due to tobacco -Chemical may be directly carcinogenic or may be a co-carcinogen. Physical Carcinogenesis -The repetitive need for tissue repair leads to DNA mutations -Radiation (UV and ionizing) induce the need for repair and directly damage DNA -Viruses break and mutate the DNA strand of the affected cells. Dietary Factors -Less conclusive but have been shown to be linked to cancer -Avoid excessive red meat, animal fat, nitrates (processed meats) & alcohol. Increase intake of bran, cruciferous vegetables & foods high in Vitamins A and C Immune Function -NK cells and T-helper cells are the main cells responsible to preventing cancer. -Individuals with depressed immune function are at higher risk for developing cancer. Age -As a person ages, immune function tapers and exposure accumulates. -Warning signs of cancer are often overlooked as normal aging.

Extravasation of chemotherapeutic agents

Extravasation is a major complication of IV Chemotherapy with vesicants. When the IV infiltrates, the drug is given into soft tissue and due to the vesicant nature, the tissue is destroyed If not prevented: Heat or cold may be applied dependent on the particular agent used. Antidotes or chemoprotective agents may be injected into the site. Surgery may be needed.

What form is communication is the best and most accurate

Face to face

What side effects are associated with hormonal therapy for males and females?

Females -Masculine hair pattern -Amenorrhea -Loss of breast tissue -Acne -Fluid retention -Hypocalcemia -Liver dysfunction -VTE Males -Female hair pattern -Thinner facial skin -Female fat pattern -Gynecomastia -Bone loss -Testicular and penile atrophy -VTE -Fluid retention -Hypocalcemia -Liver dysfunction

Transcultural nursing:

Focus on health, care and illness patterns of people with similarities and differences in their cultural beliefs, values and practices.

Explain the grading system for cellular characteristics.

Grading addresses how malignant a tumor is. The more aggressive and less similarity to the tissue of origin, the higher the grade. Ploidy refers to chromosome appearance and number. Cancers cells may have increased or decreased numbers of chromosomes. Cancer cells may develop a new chromosome type. For example the Philadelphia chromosome as seen in CML. Staging determines the location and spread of the tumor. Tumor, node, metastasis system most widely used.

What is the role of hormonal therapy in treating patients with cancer?

Hormonal Therapy are used to deprive tumors of what they need to grow. Hormonal Therapy may be given in the form of antagonists, or inhibitors. Excess hormones may be given.

Culture:

Integrated patterns of behavior acquired over time. They include beliefs, values, customs, norms, habits, language, thoughts and ways of life.

What is evidence based practice and why is it important to the delivery of safe-high quality care?

Integration of the BEST current evidence and practices to make decisions about patient care.

What are key features on anemia

Integumentary Manifestations • Pallor, especially of the ears, the nail beds, the palmar creases, the conjunctivae, and around the mouth • Cool to the touch • Intolerance of cold temperatures • Nails become brittle and may lose the normal convex shape; over time, nails become concave and fingers assume clublike appearance Cardiovascular Manifestations • Tachycardia at basal activity levels, increasing with activity and during and immediately after meals • Murmurs and gallops heard on auscultation when anemia is severe • Orthostatic hypotension Respiratory Manifestations • Dyspnea on exertion • Decreased oxygen saturation levels

Neutropenia

Suggest biological response modifiers (BRM) and growth factors to counteract the myelosuppression. Be aware most infections are caused by the patient's normal flora and may be fungal, bacterial, or viral. Blood counts generally return to normal once therapy is stopped, however sometimes therapy is aborted due to infection or infection risk. The PRIORITY nursing interventions for neutropenic patients are to protect the patient from infection in the hospital and to educate the patient and family on how to prevent infection in the home. Signs & Symptoms (S&S) of infection are likely to be vague because a patient on Chemotherapy has a depressed immune response - fever and purulent drainage may not manifest. Nursing assessment is crucial as a delay in treatment may be the difference between life and death. Many patients are at home while on chemotherapy, therefore teaching the patient and families how to recognize and prevent infection is hallmark. Patients are continually at risk for developing infection, but are not an infection threat to others.

What is adult health nursing?

Taking care of people from the age of 18-100+. Majority are 65+.

Peripheral neuropathy

The exact mechanism is unknown. Chemotherapy drugs produce varying degrees of neuropathy and the expression is dose dependent. Types -Loss of sensation in the feet or hands -Orthostatic hypotension -Erectile dysfunction -Neuropathic pain -Loss of taste -Constipation Priority nursing interventions are to protect from injury. Inspect feet Prevent falls Help develop alternate activities to compensate for the loss of fine motor skills Refer for erectile dysfunction meds. Assess the patient's ability to cope with the changes

What is the nurse's role who is caring for the patient receiving chemotherapy?

The goal is to protect the patient from life threatening side effects and manage the distressing side effects. For some the side effects are so miserable, patients opt to stop taking the chemotherapy.

Explain the TNM staging scale for cancer.

The higher the number the worse it is

Describe the role of the RN related to delegation

Transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation

beneficence

helping others to promote good

Paternalism

is the belief that one individual has the right to make decisions for another. It negates the client's right to autonomy

Nonmaleficence

is the ethical duty to prevent harm to the client

Justice

is the ethical principle based on the belief that everyone should be treated fairly

autonomy

is the right to independence and personal freedom, which leaves to the primacy of self determination

How does cancer impact the following and what are the associated nursing interventions: o Bone marrow o Motor and sensory o Psychosocial o Neurological o Breathing o Heart o GI tract

o Bone marrow: -Reduced immunity and blood forming -Cancer in the marrow suppresses WBC and RBC production o Motor and sensory: -Invasion of bone, brain, nerves -Pain - Bone metastasis leads to pain, fractures, spinal cord compression & hypercalcemia which leads to decreased mobility o Psychosocial: -Fear o Neurological: -Peripheral Neuropathy o Breathing and Heart: -Decreased respiratory and cardiac function -Compression of the airways and vasculature o GI tract: -Increased need for nutrients (Protein and Carbs esp.) for tumor growth Cachexia

Teletherapy

radiation is delivered from outside the patient so the patient is not radioactive

Brachytherapy

radiation is delivered from within the patient therefore the patient is radioactive. -Unsealed isotopes are given IV or PO and the patient is radio active until the isotope is eliminated. Excreta is radioactive. -Sealed isotopes are solids implanted in or near the cancer. The patient emits radio waves but excreta is not radioactive. Implants may be left in permanently or for short prescribed time periods.

Fidelity

the duty to keep ones promise or word. it refers to the obligation to be faithful to agreements, commitments, and responsibilities that one has mad to oneself and others

veractiy

the duty to the truth. it means one does not intentionally deceive or mislead clients

utility

the ethical principle that the good of many people outweigh the good of one person

What is medication reconciliation?

where you are supposed to compare the meds they should be on (and actually using) to new meds that are ordered to resolve any discrepancies

What are health CONCEPTS?

• ACID-BASE BALANCE • CELLULAR REGULATION • CLOTTING • COGNITION • COMFORT • ELIMINATION • FLUID AND ELECTROLYTE BALANCE • GAS EXCHANGE • GLUCOSE REGULATION • IMMUNITY • MOBILITY • NUTRITION • PERFUSION • SENSORY PERCEPTION • SEXUALITY • TISSUE INTEGRITY

What is acculturation?

• An involuntary process of adopting to a dominant culture. The non-dominant cultural group is often forced to learn the new culture to survive. • Positives: Has been linked to better health care access and utilization, cultural enrichment. • Negatives: Stress, anxiety, similar health outcomes as the dominant culture in future generations of first-generation immigrants, alienation from culture of origin.

What issues do people who are homeless may possibly encounter?

• Are prone to cardiovascular disease, infection and mental disorders. • Develop a simple treatment plan and consider obstacles to care when caring for the homeless.

What safety measures should be instituted o To protect personnel in the hospital? o To protect others when outpatients receive radiation therapy?

• Assign the patient to a private room with a private bath. • Place a "Caution: Radioactive Material" sign on the door of the patient's room. • If portable lead shields are used, place them between the patient and the door. • Keep the door to the patient's room closed as much as possible. • Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure. • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient). • Pregnant nurses should not care for these patients; do not allow pregnant women or children younger than 16 years to visit. • Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source. • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use a long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient's room. • Save all dressings and bed linens in the patient's room until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people.

Mucositis

• Examine your mouth (including the roof, under the tongue, and between the teeth and cheek) every 4 hours for fissures, blisters, sores, or drainage. • If sores or drainage is present, see your health care provider to have these areas cultured. • Brush the teeth and tongue with a soft-bristled brush or sponges every 8 hours and before meals. • Rinse the mouth with a solution of one-half peroxide and one-half normal saline every 12 hours. • Avoid the use of mouthwashes that contain alcohol or glycerin. • Rinse your mouth four times daily with a bland rinse. • Drink 2 or more liters of water per day if another health problem does not require limiting fluid intake. • Take antimicrobial drugs as prescribed. • Use topical analgesic drugs as prescribed or as needed. • "Swish and spit" room-temperature tap water or normal saline as needed. • Apply a water-based moisturizer to your lips after each episode of mouth care and as needed. • Use prescribed "artificial saliva" or mouth moisturizers as needed. • Avoid using tobacco or drinking alcoholic beverages . • Avoid spicy, salty, acidic, dry, rough, or hard food. • Cool liquids to prevent burns or irritation. • If you wear dentures, use them only during meals. When not in place, soak dentures in an antimicrobial solution. Rinse thoroughly before placing them in your mouth.

What are some quality indicators?

• Falls • Falls with injury • Pressure Injury • Turnover

Best Practice for Patient Safety & Quality Care and Prevention of Injury for the Patient with Thrombocytopenia

• Handle the patient gently. • Use and teach UAP to use a lift sheet when moving and positioning the patient in bed. • Avoid IM injections and venipunctures. • When injections or venipunctures are necessary, use the smallest-gauge needle for the task. • Apply firm pressure to the needle stick site for 10 minutes or until the site no longer oozes blood. • Apply ice to areas of trauma. • Test all urine and stool for the presence of occult blood. • Observe IV sites every 4 hours for bleeding. • Instruct patients to notify nursing personnel immediately if any trauma occurs and if bleeding or bruising is noticed. • Avoid trauma to rectal tissues: •Do not administer enemas. •If suppositories are prescribed, lubricate liberally and administer with caution. • Measure the patient's abdominal girth daily. • Instruct the patient and UAP to use an electric shaver rather than a razor. • When providing mouth care or supervising others in providing mouth care: • Use a soft-bristled toothbrush or tooth sponges. • Do not use water pressure gum cleaners. • Make certain that dentures fit and do not rub. • Instruct the patient not to blow the nose or insert objects into the nose. • Instruct UAP and the patient that the patient should wear shoes with firm soles whenever ambulating. • Keep pathways and walkways clear and uncluttered.

What are some examples of patient centered care?

• Pet therapy • Massage therapy • Guided imagery • Biofeedback • Exercise and fitness programs • Nutritional supplements • Massage therapy • Health-focused television • Music therapy • Acupuncture • Acupressure • Disease management programs

Care of the Patient with Myelosuppression and Neutropenia

• Place the patient in a private room whenever possible. • Use good handwashing technique or use alcohol-based hand rubs before touching the patient or any of the patient's belongings. • Ensure that the patient's room and bathroom are cleaned at least once each day. • Do not use supplies from common areas for patients with myelosuppression and neutropenia. For example, keep a dedicated box of disposable gloves in his or her room and do not share this box with any other patient. Provide single-use food products, individually wrapped gauze, and other individually wrapped items. • Limit the number of health care personnel entering the patient's room. • Monitor vital signs every 4 hours, including temperature. • Inspect the patient's mouth at least every 8 hours. • Inspect the patient's skin and mucous membranes (especially the anal area) for the presence of fissures and abscesses at least every 8 hours. • Inspect open areas, such as IV sites, every 4 hours for manifestations of infection. • Change wound dressings daily. • Obtain specimens of all suspicious areas for culture (as specified by the agency), and promptly notify the physician. • Assist the patient in coughing and deep-breathing exercises. • Encourage activity at a level appropriate for the patient's current health status. • Change IV tubing daily, or according to unit protocol. • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer). • Limit visitors to healthy adults. • Use strict aseptic technique for all invasive procedures. • Monitor the white blood cell count, especially the absolute neutrophil count (ANC), daily. • Avoid the use of indwelling urinary catheters. • Keep fresh flowers and potted plants out of the patient's room - hospital policy based. • Teach the patient to avoid eating raw fruits and vegetables; undercooked meat, eggs, and fish; pepper; and paprika.

What are the different types of health care organizations?

• Private • Public • For profit • Non profit

What did Purnell's Domain propose?

• Proposed 12 essential areas to assess and understand a culture. • Each domain includes concepts that need to be assessed when providing care to patients in various settings. • These domains can also be used to help nurses understand their own culture.

Peripheral neuropathy Patient and Family Education: Preparing for Self-Management

• Protect feet and other body areas where sensation is reduced (e.g., do not walk around in bare feet or stocking feet; always wear shoes with a protective sole). • Be sure shoes are long enough and wide enough to prevent creating sores or blisters. • Buy shoes in the afternoon or evening to accommodate any size change needed for foot swelling. • Provide a long break-in period for new shoes; do not wear new shoes for longer than 2 hours at a time. • Avoid pointed-toe shoes and shoes with heels higher than 2 inches. • Inspect your feet daily (with a mirror) for open areas or redness. • Avoid extremes of temperature; wear warm clothing in the winter, especially over hands, feet, and ears. • Test water temperature with a thermometer when washing dishes or bathing. Use warm water rather than hot water (less than 105° F). • Use potholders when cooking. • Use gloves when washing dishes or gardening. • Do not eat foods that are "steaming hot"; allow them to cool before placing them in your mouth. • Eat foods that are high in fiber (e.g., fruit, whole grain cereals, vegetables). • Drink two to three liters of fluid (nonalcoholic) daily unless your health care provider has told you to restrict fluid intake. • Get up from a lying or sitting position slowly. If you feel dizzy, sit back down until the dizziness fades before standing; then stand in place for a few seconds before walking or using the stairs. • Look at your feet and the floor or ground where you are walking to assess how the ground, floor, or step changes to prevent tripping or falling. • Avoid using area rugs, especially those that slide easily

Best Practice for Patient Safety & Quality Care with anemia

• Reassure the patient that fatigue is temporary and energy levels will improve over a period of weeks to months. Stress that a return to previous energy levels may take as long as a year. • Teach the patient that shortness of breath and palpitations are symptoms of over-activity. • Instruct the patient to stop activity when shortness of breath or palpitations are present. • Space care activities at least an hour apart, and avoid the time right before or right after meals. • Schedule care activities at times when the patient has more energy (e.g., immediately after naps). • Perform complete bed bath only every other day. In between complete baths, ensure cleansing of face, hands, axillae, and perineum. • In collaboration with other members of the health care team, cancel or reschedule non-essential tests and activities. • Provide four to six small, easy-to-eat meals instead of three larger ones. • Urge the patient to drink small amounts of protein shakes or other nutritional supplements. • During periods of extreme fatigue, encourage the patient to allow others to perform personal care. • Help the patient identify one or two lead visitors (those designated as able to visit at any time and who do not disturb the patient). • Selectively limit non-lead visitors when the patient is resting or sleeping. • Remind families that, although independence is important, independence in ADLs during extreme fatigue can be detrimental to the patient's health. • Monitor oxygen saturation and respiratory rate during any activity to determine patient responses and activity tolerance.

What considerations should nurses take into account in regard to nutrition?

• Respect patient's preferences and beliefs about food and what it means to them. • Coordinate the diet with the registered dietician to ensure that patients receive foods they can tolerate and are culturally appropriate.

Describe the "Rights" if delegation

• Right Task • Right Circumstances • Right Person • Right Communication • Right Supervision

What does joint commission require in regard to spirituality? How can nurses support the spirituality of patients and their families?

• Spirituality: Religious beliefs & practices, use of prayer, practices that give meaning to life. • The joint commission requires all health care facilities to address the spiritual needs of their patients. • Professional chaplains that are trained to help patients meet their spiritual needs are available in most healthcare facilities. • They assist families to allay fear and anxiety and help them cope with their loved one's illness or end of life. • They can support staff when difficult situations occur.

What does the Joint Commission recommend to ensure patient centered care?

• Understandable discharge instructions • Explanation of self care activities • Ongoing emergency care information • List of community resources • Knowledge of language, culture, and health literacy • Medication reconciliation

What are guidelines for communicating with Non-English-speaking patients?

• Use dialect-specific interpreters who are the same gender and about the same age as the patient if possible. •Use interpreters who are familiar with health and health care. • Avoid the use of relatives to prevent bias and misinterpretation. • Speak slowly and allow the patient time to translate and process what is being discussed. • Use common words in the patient's language if known; become familiar with terms that are frequently used in health care. • Maintain eye contact with the patient and family while communicating, unless it is not culturally acceptable. • Remember that most patients can understand English better than they can speak it. • Be careful with nonverbal facial expressions and body language.

What can the nurse do prevent and provide comfort for the side effects of radiation?

• Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiologist. • Use your hand rather than a washcloth to be gentler. • Rinse soap thoroughly from your skin. • If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. • Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft towel or cloth. • Use only powders, ointments, lotions, or creams on your skin at the radiation site that are prescribed by the radiation oncology department. • Wear soft clothing over the skin at the radiation site. • Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. • Avoid exposure of the irradiated area to the sun. •Protect this area by wearing clothing over it. •Try to go outdoors in the early morning or evening to avoid the more intense sun rays. •When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 am to 7 pm). • Avoid heat exposure.

What is culture shock?

•A disorder that occurs in response to transition from one cultural setting to another. A person's former behavior patterns are ineffective in such a setting and basic cue for social behavior are absent. Expressions of shock may range from silence, immobility, agitation, rage or fury. •Can occur in hospitalized patients that have to adapt to a foreign situation.

What are the different types of homelessness?

•Absolute: Having no physical home •Relative: Have some sort of shelter, but it may not be safe or sanitary.

What are the steps of the nursing process?

•Assessment-Noticing •Analysis-Interpreting/NU DX •Planning and Implementation-Responding •Evaluation-Reflecting

What health disparities (health problems) do lesbian, gay, bisexual, and transgender individuals encounter?

•Lesbians: Higher incidence of substance abuse and obesity. Are more prone to lung cancer, cardiovascular disease, depression and suicide. •Bisexual women engage in more substance abuse, report more back problems, digestive disorders, & chronic fatigue. •Gay men or MSM: Higher rates of colon & anal cancers, eating disorders, risky sexual behaviors, substance abuse, depression & suicide. •Transgendered: Exogenous hormones increase cardiovascular risks, liver disease, diabetes, high lipids, infertility, malignant or benign liver tumors.

Who are the members of the interprofessional team?

•Patient •Family •Nurses •Unlicensed Assistive Personnel (UAP) •Other health professionals and their assistants •Physician •Respiratory Therapy •Occupational Therapy •Physical Therapy

Describe and define the 6 ethical principles

•Patient autonomy •Beneficence •Nonmaleficence •Fidelity •Veracity •Social justice