Acute & Chronic Exam 2

When using restraint, how often do you need to check on the patient?

every 15 minutes

Teaching plans for older adults

1. Assessment of the patient's ability and readiness to learn 2. Identification of teaching needs 3. Development of learning goals with the patient 4. Implementation plans for the teaching 5. Evaluation of the patients learning

Neglect

failure or refusal to provide basic life needs, including food, water, medications, clothing, hygiene. Older adults report of being neglected. Untreated or infection pressure injuries on sacral area, hells, weight loss, malnutrition

Indigenous American culture distinguishes

"2-spirt" as those born of one gender who take on a role or identity of the opposite gender

The nurse is performing a health history on an adolescent female. What statement made by the patient indicates to the nurse that the patient may be experiencing gender dysphoria? "I want to wear dresses every day." "I want to be a boy and date girls." "I want to be in the beauty pageant." "I cannot wait to become pregnant."

"I want to be a boy and date girls."

Which statement by the nurse demonstrates the use of a motivational interviewing technique? "Tell me about the concerns you have about changing your diet." "You have a big weakness for ice cream; we will need to change that." "I would not want to change my diet, but I would do it so I don't get sicker." "I feel sorry for you, but you must change your diet if you plan to feel better."

"Tell me about the concerns you have about changing your diet."

A patient with a long-standing history of type 1 diabetes has brought several printouts from websites to the most recent visit with the primary care provider. Which statement would the nurse make to the patient regarding health information on the Internet? "It is best to make sure that you avoid websites that are not associated with a government agency." "You may have some good information there, but it is best to focus only on the information the doctor provides to you." "There is a great deal of misinformation on the Internet, so it is best to focus on printed material rather than electronic sources." "There are websites that are credible and reliable, and I can give you information on making those decisions if you like."

"There are websites that are credible and reliable, and I can give you information on making those decisions if you like."

Which question would the nurse ask when assessing the patient's understanding of managing a wound care dressing? "What will you do if the dressing becomes soiled?" "Do you want to watch me change your dressing?" "Do you understand how to put on a clean dressing?" "Do you think you can change your dressing at home?"

"What will you do if the dressing becomes soiled?"

When older adults are using medications, it is important to take the following measure to prevent medication errors:

- Assess cognitive function and monitor for changes - Assess their ability to self-administer medication - Obtain and maintain a complete medical record - Assess for alcohol and illicit drug use - Encourage the use of written or electron medication-reminder systems - Encourage the use of 1 pharmacy

Causes of medication errors by older adults

- Decreased vision - Forgetting to take drugs - Taking drugs incorrectly - Use of drugs prescribed for someone else - Lack of financial resources to obtain prescription drugs - Refusal to take a drug because of undesirable side effects - Failure to understand instructions or importance of drug treatment

4 M's

- Matters: goals and preferences - Medication: do they know what they are taking and why - Mentation: managing dementia, delirium or depression - Mobility: managing function?

Adult learning principle: Prior experiences

- Motivation is increased when one already knows something about the subject from past experiences - Identification of past knowledge and experiences can help find familiar ground to increase patients confidence

Adult learning principle: Self-concept

- Patients need control and self direction to maintain their sense of worth - Patients do not learn when we treat them like children and tell them what they must do

Adult learning principle: Need to know

- Patients need to know why they should learn something, what they need to learn, and how it will help them - Ask the patient questions such as, "what do you think you need to learn about this topic." Your patient and his caregiver ask what they need to. Know about exercise guidelines after a heart attack

Adult learning principle: Motivation to learn

- Patients prefer to apply learning at once - Long-term goals may have less appeal than short-term goals - Focus teaching on information that the patient views as needed right now

Adult learning principle: Orientation to learning

- Patients seek out various resources for specific learning and prefer choices - When the patient does not recognize the relevancy of the teaching, offer an explanation of the value of the learning - Teaching should target specific problems or circumstances

Adult learning principle: Readiness to learn

- Readiness and motivation to learn are high when facing new tasks - Health crises provide opportunities for patients to learn and change behavior - Stress and anxiety may interfere with learning, this requiring frequency reinforcement of content

SCALES

- Sadness, or mood change - Cholesterol, high - Albumin, low - Loss or gain of weight - Eating problems - Shopping and food preparation problems

SPICES

- sleep disorders - Problems with eating or feeding - Incontinence - Confusion - Evidence of falls - Skin breakdown

7 tasks of chronic illness

1. Preventing and managing a crisis: understanding a potential for crisis and how to prevent or modify the threat - Ex: asthma, aspiration, hypertension, diabetes, asthma 2. Carrying out prescribed treatment regimen: may be challenging or impact lifestyle - Ex: doing a dressing change 3. Controlling symptoms: modify lifestyle or living situation to maintain safety - Ex: when to take medication for diuretic 4. Reordering time: change schedule and/or eliminate activities - Ex: plan ahead 5. Adjusting to changes in the course of disease: include chronic illness as part of identity and make necessary lifestyle changes 6. Preventing social isolation: patient chooses to withdraw, or others don't associate with patient - Someone who had a stroke and no longer talks/chews properly 7. Attempting to normalize interactions with others: manage symptoms to hide disability - Eat before/ make sure they can order something from the menu prior

Young-old adult

65 to 74 years of age Typically healthier, independent, good cognitive function

Old adult

85 years of age and older Often widowed, divorced, single female dependent on family for support or care who has outlived children, partners, siblings

A nurse is interested in providing care for persons with chronic illnesses. Where would the nurse identify that most chronic illnesses are managed? Hospice care Homeless shelters A community setting An acute care hospital

A community setting

Medicare

A federal program of health insurance for persons 65 years of age and older

The nurse is supervising assistive personnel (AP) providing hygiene care to older adult residents in a care facility. What behavior indicates further AP education is required? Compassion for weakness and low activity Identification of progressive loss of function A negative attitude based on the age of the patient Providing culturally competent care to older adults

A negative attitude based on the age of the patient

A nurse is caring for an adult who sustained a severe traumatic brain injury following a motor vehicle accident. Which type of practice setting will the nurse prepare the patient for on discharge? Assisted living Acute rehabilitation Long-term acute care Skilled nursing facility

Acute rehabilitation

The nurse is developing a plan of care for an older adult patient. What must the nurse include in the plan of care? Patient priorities should be the only focus of care. Additional time related to declining energy reserves. Reduction of disease and problems should be the focus. Tobacco cessation will help the patient cope with other illnesses.

Additional time related to declining energy reserves.

A patient with Alzheimer's disease has increased evidence of dementia and physical deterioration. Which would be the best assistance to recommend to the caregiver spouse who is exhausted? Adult day care Long-term care Home health care Homemaker services

Adult day care

Hormone: Estradiol

Affects: Breast growth, erectile dysfunction, fat redistribution from the abdomen to the hips, decreased libido, decreased prostate and testicular size, skin softens

Estradiol: Testosterone

Affects: Increased abdominal fat, acne, deepening voice, increased facial hair, increased muscle mass, vaginal dryness, oily skin

The nurse is performing an assessment for an older adult patient suspected of elder mistreatment. Which assessment findings would lead the nurse to notify social services? (Select all that apply.) Agitation Depression Weight gain Weight loss Hypernatremia

Agitation Depression Weight loss Hypernatremia

Adult day health care

higher level of care; monitoring and training

A patient is diagnosed with chronic obstructive pulmonary disease (COPD). At what point should the nurse begin to include the patient's spouse in the teaching around the management of the disease? As soon as possible When the patient requests help from the spouse and family When the patient becomes unable to manage symptoms independently After the patient has had the opportunity to adjust to the treatment regimen

As soon as possible

Which teaching method individualizes learning for a patient's unique needs? Using prepackaged learning materials Only teaching the patient "need-to-know" information Asking the patient to choose topics in order of priority Having the patient watch a video and then read a pamphlet

Asking the patient to choose topics in order of priority

Which actions by the nurse best demonstrate awareness of learning styles and the role the nurse plays in patient and caregiver teaching? (Select all that apply.) Assess patients' preferred learning styles before teaching. Prioritize the learning style with which the patient is most familiar and comfortable. Use materials that appeal to a variety of learning styles, including the styles identified by the patient. Provide written instructions to younger patients while using visual and audio aids when teaching older patients. Provide visual and audio aids to younger patients while using written instructions when teaching older patients

Assess patients' preferred learning styles before teaching. Prioritize the learning style with which the patient is most familiar and comfortable. Use materials that appeal to a variety of learning styles, including the styles identified by the patient.

The nurse is admitting a patient to the medical unit. The nurse recognizes that the patient has a feminine gender identity whose sex assigned at birth was male or intersex. This is known as hijras two-spirit. burrnesha. non-binary.

hijras

Which criterion must a 65-yr-old person meet in order to qualify for Medicare funding? Being entitled to Social Security benefits A documented absence of family caregivers A validated need for long-term residential care A history of failed responses to standard medical treatments

Being entitled to Social Security benefit

A nurse who is providing care for an older adult patient recognizes the need to maximize the patient's mobility during recovery from surgery. What accurately describes the best rationale for the nurse's actions? Continued activity prevents deconditioning. Pharmacokinetics are improved by patient mobility. Lack of stimulation contributes to the development of cognitive problems in older adults. Regularly scheduled physical rehabilitation provides an important sense of purpose for older patients.

Continued activity prevents deconditioning.

The nurse is interviewing an older adult patient. What is the priority nursing action during the interview process? Ensure all assistive devices are in place. Interview the patient and caregiver together. Perform the interview before administering analgesics. Move on to the next question if the patient does not respond quickly.

Ensure all assistive devices are in place.

A patient has a history of hypertension and type 1 diabetes. The patient exercises and eats a healthy diet. Which factors will most likely have a positive impact on biologic aging? (Select all that apply.) Exercise Diabetes Social support Good nutrition Coping resources

Exercise Social support Good nutrition Coping resources

Home health care

homebound, intermittent or acute health needs, supportive caregiver involvement, need physician order and require skilled nursing care for Medicare reimbursement

Based on adult learning principles, which situation indicates that the patient is ready to learn about performing a subcutaneous injection at home? The patient is requesting pain medication. The patient is falling asleep while watching the teaching DVD. The patient asks to practice before injecting himself with the needle. The patient is nervous and says he cannot do it as he picks up the syringe.

The patient asks to practice before injecting himself with the needle.

A patient repeatedly asks about the purpose and potential side effects of each oral medication received while in the hospital. How would the nurse best interpret the patient's questions? The patient has an auditory learning style. The patient is identifying his learning needs. The patient is exhibiting a high level of health literacy. The patient has anxiety related to his diagnosis and treatment.

The patient is identifying his learning needs.

A female patient with incontinence arrives early for appointments and social events so there is ready access to the restroom. Which tasks of the chronically ill is the patient demonstrating? (Select all that apply.) Controlling symptoms Preventing social isolation Preventing and managing a crisis Denying the reality of the problem Adjusting to changes in the course of the disease

controlling symptoms Preventing social isolation Preventing and managing a crisis

Seniors at a community center ask the nurse to suggest computer websites where they can learn more about health. Which websites would the nurse recommend provide accurate and current health information for these older adults? Government websites Commercial websites Websites designed for health professionals Websites developed by an anonymous person

Government websites

Which teaching techniques would be most appropriate to enhance patient learning? (Select all that apply.) Obtain frequent feedback. Explain all information in great detail. Involve the patient and caregiver in the process. Choose the learning format that is most readily available. Emphasize relevance of the information to the patient's life.

Obtain frequent feedback. Involve the patient and caregiver in the process. Emphasize relevance of the information to the patient's life.

The nurse is planning discharge for a frail older adult patient covered under Medicare Part A health insurance. Which medical supply would be covered if needed? Walker Dentures Eyeglasses Hearing aids

Walker

Societal changes influence

cultural practices, language, food preferences, neighborhoods safety, financial resources

Which teaching strategy would be the best choice for a 20-yr-old patient? Lectures or books Websites or podcasts Television or pamphlets Role playing or support groups

Websites or podcasts

The nurse plans teaching for adult patients who are scheduled in the primary care office this week. Which general goal will the nurse plan to meet? Decreased pain Health promotion Disease identification Increased quantity of life

Health promotion

An older adult patient admitted with an irregular heart rhythm has a lower blood level of medication than expected. Which common cause of medication errors made by older adults should the nurse suspect? Shorter drug half-life leading to medication overdose Decreased use of nonprescription over-the-counter drugs Improved tolerance of adverse effects of prescribed drugs Lack of financial resources to obtain prescribed medications

Lack of financial resources to obtain prescribed medications

Ethnogeriatric specialty

culturally competent care for older adult

A frail older adult with chronic heart failure is cared for in the home by her only child. Which problem is most indicated by the caregiver's failure to provide companionship or social stimulation? Neglect Sexual abuse Abandonment Violation of personal rights

Neglect

A patient will need to change a dressing on an open leg wound after discharge. Which strategy would the nurse use to evaluate if the patient is able to perform the dressing change? Have the patient complete the dressing change on a model. Ask the patient to write down each step of the dressing change. Observe the patient completing the dressing change on himself. Provide printed instructions with pictures of how to do his dressing change.

Observe the patient completing the dressing change on himself.

In anticipation of a Joint Commission visit, the nurse has been assigned to review the policies and guidelines for compliance with promoting an inclusive environment for all patients. What actions would the nurse implement as part of the accreditation process? (Select all that apply.) Signage displayed with the rainbow flag. Avoid intake forms on sexual and gender identity. Discourage staff to wear visual cues on ID badges. A visible display of an inclusive patient bill of rights. Posters that have same sex couples or transgender couples.

Signage displayed with the rainbow flag. A visible display of an inclusive patient bill of rights. Posters that have same sex couples or transgender couples.

Which teaching strategy is the nurse's best choice for a person born before 1945? Schedule group teaching sessions. Show video recordings on a television. Provide printed materials with diagrams. Download information to an electronic device.

Provide printed materials with diagrams.

Psychological Abuse

Psychological Abuse: being verbally, harassing, intimidation, threats of punishment, or deprivation Depression, withdrawn behavior, agitation

A patient is in the contemplation stage of the behavior change model regarding her tobacco use. Which action would the nurse take? Reinforce the stated need for change. Reinforce the positive outcomes of change. Increase the awareness of the need for change. Help the patient plan to deal with potential relapses.

Reinforce the stated need for change.

Financial Abuse:

denying access to personal resources, stealing money or possessions. Coercing to sign contracts or durable power of attorney. Making changes in will or trust Living situation below level of personal resources. Sudden change in personal finances, sudden transfer of assets

Violation of Personal Rights

denying right to privacy or right to make decisions about health care or living environment Sudden inexplicable changes in living situation, confusion

The nurse is caring for a transgender male on Gender Affirming Hormone Therapy (GAHT) admitted with chronic obstructive pulmonary disease. While reviewing the home medication record, the nurse recognizes the importance of continuing which medication? Estradiol Finasteride Testosterone Spironolactone

Testosterone

The nurse is administering medication to an older adult patient. Which consideration most related to aging would the nurse monitor when administering medications? The excretion of the medication The absorption of the medication How the medication is distributed The ability of the medication to metabolize

The ability of the medication to metabolize

Abandonment

desertion of an older person by a person who has assumed responsibility for providing care or by a person with physical custody older adult reports of being abandoned, deserting an older adult at a hospital or skilled nursing facility, shopping center, or other public places

Primary health prevention

diet, exercise, immunizations o Prevent it before it occurs

The patient reports preferring to learn by watching how things are done rather than reading information or instructions. Which teaching strategy would be best for this patient? Viewing a videorecording Talking about the care with the nurse Reading a book with color pictures demonstrating the skill Using the Internet to find blogs written by patients with similar care needs

Viewing a videorecording

Secondary health prevention

early detections/screenings o Mammogram, colonoscopy, ect

Madicaid

a government medical assistance program based on need

Advanced directives

a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

Biological sex

also called sex assigned at birth is determined by a person's external genitalia, internal reproductive organs, and chromosomes

Action

begins to change behavior through practice. Tentative and may experience relapses

Termination

change has become part of lifestyle. Behavior no longer considered a change

Elder Mistreatment

intentional acts of omission or commission by a caregiver or trusted other; causes harm or serious risk for harm to a vulnerable older adult

Gender Dysphoria

is a diagnostic classification that describes the distress that occurs when there is a conflict between a person's gender identity and their sex assigned at birth

Motivational Interviewing

is a nonconfrontational communication method to motivate patients to change behavior

Hijras

is known as in India a feminine gender identity taken on by persons whose sex assigned at birth was male or intersex

Learning

is the act of acquiring knowledge or skills that may produce a change in behavior - Patient has right to choose if change occurs

Teaching

is the act of conveying information to facilitate learning - DOCUMENT!! If it wasn't documented it wasn't taught

A patient arrived at the surgical suite to have a facial feminization procedure. The nurse understands this procedure will use fat transferred from another part of the body. make the face softer and more feminine in appearance. remove breast tissue and reshape to have a more masculine appearance. involve grafting additional skin and muscle from another part of the body.

make the face softer and more feminine in appearance

Sexual Abuse

nonconsensual sexual contact, including inappropriate touching Older adults report sexual abuse unexplained vaginal or anal bleeding, and bruised breasts.

Transexual

old, outdates term for persons who use medical intervention to change their bodies

Maintenance

practices the behavior regularly. Able to sustain the change.

Chronic Illness

prolonged illness, no cure; results in irreversible changes, possible disability; requires rehab and/or long-term medication management and nursing care Ex: arthritis, COPD, diabetes, stroke, heart failure

Precontemplation

the patient is not considering a change. Is not ready to learn

A nurse selected to serve on the community health advisory board is placed in charge of promoting the health and well-being of the LGBTQ+ persons. What would be the nurse's recommendations to promote health and well-being in the LGBTQ+ community? (Select all that apply.) Provide supportive social services to reduce suicide. Limit the training about health needs related to mental health. Implement anti bullying policies in schools and the workplace. Continue efforts to expand domestic partner health insurance coverage. Disseminate effective HIV and sexually transmitted infection interventions.

provide supportive social services to reduce suicide. Implement antibullying policies in schools and the workplace. Continue efforts to expand domestic partner health insurance coverage. Disseminate effective HIV and sexually transmitted infection interventions.

Adult day care

provides social and recreational services, and ADL assistance in supervised setting Serves 2 groups of adults: o Cognitively impaired o Unable to perform ADLs independently

Gender affirming hormone therapy:

provides transgender persons the opportunity to transition from their sex assigned at birth to the gender that aligns with their sense of being.

Acute illness

rapid onset, short duration; return to previous level of function after treatment Ex: colds, flu, GI virus

Traditional western culture

recognizes a binary construct- male or female

Gender Identity

refers to a person's self-perceived gender

Sexual orientation

refers to how one identifies based on their sexual or romantic attraction to others

Cisgender

refers to persons whose gender identity aligns with their sex assigned at birth

Transgender

refers to someone whose gender identity or gender expression is different than their sex assigned at birth

Tertiary health prevention

rehabilitation; limit progression of disease o Once you've been diagnosed, how you handle the disease

Physical Abuse

slapping, striking, restraining, incorrect positioning. Oversedation with medications Bruises, bilateral injuries, repeated injuries in various stages of healing, burn marks, and oversedation.

Preparation

started planning the change, gathers information, sets a date to start change, shares decision to change with others

Gender affirming surgery

surgical procedures performed to either create more masculinizing features in a transgender man or feminizing features in a transgender woman.

Contemplation

thinks about a change. May state recognition of need to change. Says "I know I should," but identifies barriers

Frail older adult

usually over age 75 Multiple physical, cognitive and/or mental conditions

Burrnesha

women of Albanian culture who take a vow to celibacy and live as men